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Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022; 42:e1-e141. [PMID: 37080658 DOI: 10.1016/j.healun.2022.10.015] [Citation(s) in RCA: 238] [Impact Index Per Article: 79.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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3
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Nimmo A, Gardiner D, Ushiro-Lumb I, Ravanan R, Forsythe JLR. The Global Impact of COVID-19 on Solid Organ Transplantation: Two Years Into a Pandemic. Transplantation 2022; 106:1312-1329. [PMID: 35404911 PMCID: PMC9213067 DOI: 10.1097/tp.0000000000004151] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 02/06/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had a major global impact on solid organ transplantation (SOT). An estimated 16% global reduction in transplant activity occurred over the course of 2020, most markedly impacting kidney transplant and living donor programs, resulting in substantial knock-on effects for waitlisted patients. The increased severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection risk and excess deaths in transplant candidates has resulted in substantial effort to prioritize the safe restart and continuation of transplant programs over the second year of the pandemic, with transplant rates returning towards prepandemic levels. Over the past 2 y, COVID-19 mortality in SOT recipients has fallen from 20%-25% to 8%-10%, attributed to the increased and early availability of SARS-CoV-2 testing, adherence to nonpharmaceutical interventions, development of novel treatments, and vaccination. Despite these positive steps, transplant programs and SOT recipients continue to face challenges. Vaccine efficacy in SOT recipients is substantially lower than the general population and SOT recipients remain at an increased risk of adverse outcomes if they develop COVID-19. SOT recipients and transplant teams need to remain vigilant and ongoing adherence to nonpharmaceutical interventions appears essential. In this review, we summarize the global impact of COVID-19 on transplant activity, donor evaluation, and patient outcomes over the past 2 y, discuss the current strategies aimed at preventing and treating SARS-CoV-2 infection in SOT recipients, and based on lessons learnt from this pandemic, propose steps the transplant community could consider as preparation for future pandemics.
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Affiliation(s)
- Ailish Nimmo
- Renal Department, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
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4
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The Task Force for the management of COVID-19 of the European Society of Cardiology, Baigent C, Windecker S, Andreini D, Arbelo E, Barbato E, Bartorelli AL, Baumbach A, Behr ER, Berti S, Bueno H, Capodanno D, Cappato R, Chieffo A, Collet JP, Cuisset T, de Simone G, Delgado V, Dendale P, Dudek D, Edvardsen T, Elvan A, González-Juanatey JR, Gori M, Grobbee D, Guzik TJ, Halvorsen S, Haude M, Heidbuchel H, Hindricks G, Ibanez B, Karam N, Katus H, Klok FA, Konstantinides SV, Landmesser U, Leclercq C, Leonardi S, Lettino M, Marenzi G, Mauri J, Metra M, Morici N, Mueller C, Petronio AS, Polovina MM, Potpara T, Praz F, Prendergast B, Prescott E, Price S, Pruszczyk P, Rodríguez-Leor O, Roffi M, Romaguera R, Rosenkranz S, Sarkozy A, Scherrenberg M, Seferovic P, Senni M, Spera FR, Stefanini G, Thiele H, Tomasoni D, Torracca L, Touyz RM, Wilde AA, Williams B. ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2-care pathways, treatment, and follow-up. Cardiovasc Res 2022; 118:1618-1666. [PMID: 34864876 PMCID: PMC8690236 DOI: 10.1093/cvr/cvab343] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular (CV) disease in association with COVID-19. METHODS AND RESULTS A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, which was reported previously, focused on the epidemiology, pathophysiology, and diagnosis of CV conditions that may be manifest in patients with COVID-19. This second part addresses the topics of: care pathways and triage systems and management and treatment pathways, both of the most commonly encountered CV conditions and of COVID-19; and information that may be considered useful to help patients with CV disease (CVD) to avoid exposure to COVID-19. CONCLUSION This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
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The Task Force for the management of COVID-19 of the European Society of Cardiology, Baigent C, Windecker S, Andreini D, Arbelo E, Barbato E, Bartorelli AL, Baumbach A, Behr ER, Berti S, Bueno H, Capodanno D, Cappato R, Chieffo A, Collet JP, Cuisset T, de Simone G, Delgado V, Dendale P, Dudek D, Edvardsen T, Elvan A, González-Juanatey JR, Gori M, Grobbee D, Guzik TJ, Halvorsen S, Haude M, Heidbuchel H, Hindricks G, Ibanez B, Karam N, Katus H, Klok FA, Konstantinides SV, Landmesser U, Leclercq C, Leonardi S, Lettino M, Marenzi G, Mauri J, Metra M, Morici N, Mueller C, Petronio AS, Polovina MM, Potpara T, Praz F, Prendergast B, Prescott E, Price S, Pruszczyk P, Rodríguez-Leor O, Roffi M, Romaguera R, Rosenkranz S, Sarkozy A, Scherrenberg M, Seferovic P, Senni M, Spera FR, Stefanini G, Thiele H, Tomasoni D, Torracca L, Touyz RM, Wilde AA, Williams B. ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2-care pathways, treatment, and follow-up. Eur Heart J 2022; 43:1059-1103. [PMID: 34791154 PMCID: PMC8690006 DOI: 10.1093/eurheartj/ehab697] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/08/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023] Open
Abstract
AIMS Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular (CV) disease in association with COVID-19. METHODS AND RESULTS A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, which was reported previously, focused on the epidemiology, pathophysiology, and diagnosis of CV conditions that may be manifest in patients with COVID-19. This second part addresses the topics of: care pathways and triage systems and management and treatment pathways, both of the most commonly encountered CV conditions and of COVID-19; and information that may be considered useful to help patients with CV disease (CVD) to avoid exposure to COVID-19. CONCLUSION This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
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Munting A, Manuel O. Viral infections in lung transplantation. J Thorac Dis 2022; 13:6673-6694. [PMID: 34992844 PMCID: PMC8662465 DOI: 10.21037/jtd-2021-24] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/21/2021] [Indexed: 12/15/2022]
Abstract
Viral infections account for up to 30% of all infectious complications in lung transplant recipients, remaining a significant cause of morbidity and even mortality. Impact of viral infections is not only due to the direct effects of viral replication, but also to immunologically-mediated lung injury that may lead to acute rejection and chronic lung allograft dysfunction. This has particularly been seen in infections caused by herpesviruses and respiratory viruses. The implementation of universal preventive measures against cytomegalovirus (CMV) and influenza (by means of antiviral prophylaxis and vaccination, respectively) and administration of early antiviral treatment have reduced the burden of these diseases and potentially their role in affecting allograft outcomes. New antivirals against CMV for prophylaxis and for treatment of antiviral-resistant CMV infection are currently being evaluated in transplant recipients, and may continue to improve the management of CMV in lung transplant recipients. However, new therapeutic and preventive strategies are highly needed for other viruses such as respiratory syncytial virus (RSV) or parainfluenza virus (PIV), including new antivirals and vaccines. This is particularly important in the advent of the COVID-19 pandemic, for which several unanswered questions remain, in particular on the best antiviral and immunomodulatory regimen for decreasing mortality specifically in lung transplant recipients. In conclusion, the appropriate management of viral complications after transplantation remain an essential step to continue improving survival and quality of life of lung transplant recipients.
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Affiliation(s)
- Aline Munting
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Oriol Manuel
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland.,Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland
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Global Effects of SARS-CoV-2 Era on Kidney Transplantation Activities: Analysis of WHO Data. Transplant Proc 2021; 54:1417-1423. [PMID: 34986975 PMCID: PMC8720483 DOI: 10.1016/j.transproceed.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/30/2021] [Accepted: 12/04/2021] [Indexed: 12/15/2022]
Abstract
Background Uncertainty raises questions in kidney transplant during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic regarding the recipient, the donor, and health care professionals. The pandemic not only has disrupted kidney transplanted patients but also has influenced transplant systems, donation chains, and timely and safe transplant surgeries. In the present study, we aimed to explore the global effects of the SARS-CoV-2 pandemic on kidney transplant. Methods We collected transplantation statistics and SARS-CoV-2 pandemic data from the World Health Organization website on June 15, 2021. Spearman correlation analysis was applied to assess the strength of a monotonic relationship among quantitative variables. We also demonstrated the clinical characteristics of our kidney recipients with SARS-CoV-2 infection. Results Comparison of the mean of global kidney transplantation statistics between 2010 and 2019 with 2020 statistics showed a significant decrease in kidney transplant from living donors (P < .001). From the beginning of the pandemic to June 15, 2021, 1 of the 43 kidney transplant patients we treated in our clinic died of SARS-CoV-2 infection after discharge. Two of the patients we transplanted and saw in follow-up before the pandemic died of SARS-CoV-2 infection. Conclusion While the overall kidney transplant numbers have increased in the year to date, kidney transplants decreased drastically at the onset of the pandemic.
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Fitch T, Myers KC, Dewan M, Towe C, Dandoy C. Pulmonary Complications After Pediatric Stem Cell Transplant. Front Oncol 2021; 11:755878. [PMID: 34722309 PMCID: PMC8550452 DOI: 10.3389/fonc.2021.755878] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/14/2021] [Indexed: 12/02/2022] Open
Abstract
The number of disorders that benefit from hematopoietic stem cell transplantation (HSCT) has increased, causing the overall number of HSCT to increase accordingly. Disorders treated by HSCT include malignancy, benign hematologic disorders, bone marrow failure syndromes, and certain genetic diagnoses. Thus, understanding the complications, diagnostic workup of complications, and subsequent treatments has become increasingly important. One such category of complications includes the pulmonary system. While the overall incidence of pulmonary complications has decreased, the morbidity and mortality of these complications remain high. Therefore, having a clear differential diagnosis and diagnostic workup is imperative. Pulmonary complications can be subdivided by time of onset and whether the complication is infectious or non-infectious. While most infectious complications have clear diagnostic criteria and treatment courses, the non-infectious complications are more varied and not always well understood. This review article discusses pulmonary complications of HSCT recipients and outlines current knowledge, gaps in knowledge, and current treatment of each complication. This article includes some adult studies, as there is a significant paucity of pediatric data.
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Affiliation(s)
- Taylor Fitch
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center (CCHMC), University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - Kasiani C Myers
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center (CCHMC), University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - Maya Dewan
- Division of Critical Care, Cincinnati Children's Hospital Medical Center (CCHMC), University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - Christopher Towe
- Division of Pulmonology, Cincinnati Children's Hospital Medical Center (CCHMC), University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - Christopher Dandoy
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center (CCHMC), University of Cincinnati School of Medicine, Cincinnati, OH, United States
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Koval CE, Poggio ED, Lin YC, Kerr H, Eltemamy M, Wee A. Early success transplanting kidneys from donors with new SARS-CoV-2 RNA positivity: A report of 10 cases. Am J Transplant 2021; 21:3743-3749. [PMID: 34254424 PMCID: PMC8441915 DOI: 10.1111/ajt.16765] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 01/25/2023]
Abstract
Transplantation of solid organs from donors with active SARS-CoV-2 infection has been advised against due to the possibility of disease transmission to the recipient. However, with the exception of lungs, conclusive data for productive infection of transplantable organs do not exist. While such data are awaited, the organ shortage continues to claim thousands of lives each year. In this setting, we put forth a strategy to transplant otherwise healthy extrapulmonary organs from SARS-CoV-2-infected donors. We transplanted 10 kidneys from five deceased donors with new detection of SARS-CoV-2 RNA during donor evaluation in early 2021. Kidney donor profile index ranged from 3% to 56%. All organs had been turned down by multiple other centers. Without clear signs or symptoms, the veracity of timing of SARS-CoV-2 infection could not be confirmed. With 8-16 weeks of follow-up, outcomes for all 10 patients and allografts have been excellent. All have been free of signs or symptoms of donor-derived SARS-CoV-2 infection. Our findings raise important questions about the nature of SARS-CoV-2 RNA detection in potential organ donors and suggest underutilization of exceptionally good extrapulmonary organs with low risk for disease transmission.
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Affiliation(s)
- Christine E. Koval
- Department of Infectious Diseases, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA,Correspondence Christine E. Koval, Department of Infectious Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Emilio D. Poggio
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Yi-Chia Lin
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hannah Kerr
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Eltemamy
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alvin Wee
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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10
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Bitterman R, Kumar D. Respiratory Viruses in Solid Organ Transplant Recipients. Viruses 2021; 13:2146. [PMID: 34834953 PMCID: PMC8622983 DOI: 10.3390/v13112146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/15/2021] [Accepted: 10/22/2021] [Indexed: 12/02/2022] Open
Abstract
Solid organ transplantation is often lifesaving, but does carry an increased risk of infection. Respiratory viral infections are one of the most prevalent infections, and are a cause of significant morbidity and mortality, especially among lung transplant recipients. There is also data to suggest an association with acute rejection and chronic lung allograft dysfunction in lung transplant recipients. Respiratory viral infections can appear at any time post-transplant and are usually acquired in the community. All respiratory viral infections share similar clinical manifestations and are all currently diagnosed using nucleic acid testing. Influenza has good treatment options and prevention strategies, although these are hampered by resistance to neuraminidase inhibitors and lower vaccine immunogenicity in the transplant population. Other respiratory viruses, unfortunately, have limited treatments and preventive methods. This review summarizes the epidemiology, clinical manifestations, therapies and preventive measures for clinically significant RNA and DNA respiratory viruses, with the exception of SARS-CoV-2. This area is fast evolving and hopefully the coming decades will bring us new antivirals, immunologic treatments and vaccines.
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Affiliation(s)
| | - Deepali Kumar
- Ajmera Transplant Centre, University Health Network, Toronto, ON M5G 2N2, Canada;
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BJS Commission Team, Abahuje E, Abbas A, Abd El Aziz Abd El Maksoud M, Abdelhady A, Abdelhamid S, Abdelkarem Ahmed Faraj H, Abdelqader B, Abdou H, Abdullah A, Abedua Harrison M, Abem Owusu E, Aboalazayem A, Aboulhosn R, Abu Oda S, Abubakar A, Abutaka A, Acevedo Fontalvo D, Acuna S, Adefemi A, Adegbola S, Adenuga T, Adeyeye A, Adil Hilmi A, Aditya K, Adjeso T, Aftab R, Afzal A, Aggarwal V, Aggarwal A, Aguilera R, Aguilera-Arévalo ML, Aguirre Salamanca EJ, Aguirre-Allende I, Ahari D, Ahmad H, Ahmad Rauf F, Ahmad Zartasht Khan A, Ahmed S, Ahmed Fieturi N, Ahmed Mohamed S, Ahmed-Bakhsh Z, Ahsan Javed M, Akano L, Akbar A, Akhbari M, Akhmedov P, Aksit G, Akula Y, Al Majid S, Al Mukhtar O, Al Omran H, Al-Asali N, Al-Azzawi M, Al-Habsi R, Al-Iraqi H, Al-Naggar H, Alameer E, Albirnawi H, Aldulaijan F, Alejandro Miranda Ojeda R, AlHasan A, Ali S, Ali A, Ali Khan M, Alimova Y, Aljanadi F, Aljubure R, Allopi N, Almedbal H, Almubarak M, Alqaidoom Z, Alselaim N, Alshaar M, Alshammari R, Altaf K, Altıner S, Altunpak B, Alvarez Lozada LA, Amal Nahal E, Amer A, Amin K, Aminu U, Amisi Numbi N, Amjad T, Amoah R, An Y, Anastasopoulos NA, Andrés Urrutia J, Angarita F, Angarita KL, Ángel FreirÍa Eiras M, Antypas A, Anwar MA, Anwar H, Apampa TO, Apostolou K, Aquina C, Arachchige Adithi Himika Randeni R, Archila Godínez MI, et alBJS Commission Team, Abahuje E, Abbas A, Abd El Aziz Abd El Maksoud M, Abdelhady A, Abdelhamid S, Abdelkarem Ahmed Faraj H, Abdelqader B, Abdou H, Abdullah A, Abedua Harrison M, Abem Owusu E, Aboalazayem A, Aboulhosn R, Abu Oda S, Abubakar A, Abutaka A, Acevedo Fontalvo D, Acuna S, Adefemi A, Adegbola S, Adenuga T, Adeyeye A, Adil Hilmi A, Aditya K, Adjeso T, Aftab R, Afzal A, Aggarwal V, Aggarwal A, Aguilera R, Aguilera-Arévalo ML, Aguirre Salamanca EJ, Aguirre-Allende I, Ahari D, Ahmad H, Ahmad Rauf F, Ahmad Zartasht Khan A, Ahmed S, Ahmed Fieturi N, Ahmed Mohamed S, Ahmed-Bakhsh Z, Ahsan Javed M, Akano L, Akbar A, Akhbari M, Akhmedov P, Aksit G, Akula Y, Al Majid S, Al Mukhtar O, Al Omran H, Al-Asali N, Al-Azzawi M, Al-Habsi R, Al-Iraqi H, Al-Naggar H, Alameer E, Albirnawi H, Aldulaijan F, Alejandro Miranda Ojeda R, AlHasan A, Ali S, Ali A, Ali Khan M, Alimova Y, Aljanadi F, Aljubure R, Allopi N, Almedbal H, Almubarak M, Alqaidoom Z, Alselaim N, Alshaar M, Alshammari R, Altaf K, Altıner S, Altunpak B, Alvarez Lozada LA, Amal Nahal E, Amer A, Amin K, Aminu U, Amisi Numbi N, Amjad T, Amoah R, An Y, Anastasopoulos NA, Andrés Urrutia J, Angarita F, Angarita KL, Ángel FreirÍa Eiras M, Antypas A, Anwar MA, Anwar H, Apampa TO, Apostolou K, Aquina C, Arachchige Adithi Himika Randeni R, Archila Godínez MI, Arez O, Armonis P, Arshad S, Arshad Salman M, Arshid A, Arteaga Asensio PC, Arthur T, Arumuga Jothi A, Aryo Damara F, Asensio Gomez L, Ashcroft J, Ashraf S, Asif A, Asif A, Atif M, Attaullah Khan M, Avellaneda N, Awad S, Awadh M, Axiaq A, Ayad Mohammed Shuwayyah A, Ayalew D, Aytac E, Azam F, Azevedo J, Azhar B, Aziz J, Aziz A, Azzam A, Baba Ndajiwo A, Baig M, Baker D, Bakko F, Balachandran R, Balachandran G, Balagizi Mudekereza J, Balai E, Balci B, Balduzzi A, Balhareth A, Bandyopadhyay S, Bandyopadhyay S, Banerjee D, Bangalore Mahalinga D, Bankhead-Kendall B, Bankole NDA, Banwell V, Baris Bengur F, Baris Ozmen B, Barnard M, Barnett R, Barreras Espinoza JA, Barrios A, Bass G, Bass M, Bausys A, Bavikatte A, Bayram J, Beamish A, Beattie C, Belia F, Bellato V, Bellikatti S, Benjamens S, Benlice C, Bennedsgaard S, Bennett S, Bentounsi Z, Bergenfeldt H, Bhandoria G, Bhatia M, Bhatti MT, Bilgili Z, Bislenghi G, Bisset C, Biswas S, Blake J, Blanco R, Boccalatte L, Boden R, Bojanic C, Boland M, Boland P, Bollen E, Bonci EA, Booth A, Borakati A, Borunda Escudero GE, Bosco SJ, Boström P, Botelho de Alencar Ferreira Cruz P, Bouchagier K, Bouhuwaish A, Boutros M, Boyce K, Boyle C, Bradshaw L, Brandl A, Brar A, Brenkman H, Brennan C, Brines C, Brookmyre A, Brosnan C, Brouwers L, Brown A, Brown L, Brown C, Brown C, Brown J, BS V, Buksh M, Bunani Emmanuel M, Burbano D, Burelli A, Burke A, Burke J, Burlov N, Burns A, Burton O, Butt A, Buzra Ozkan B, Cabrera Silva L, Caicedo EY, Calderbank T, Cambridge W, Campelo G, Can Tatar O, Carbone F, Carrano F, Casallas D, Casanova Portoles D, Casciani F, Cassimjee I, Castañeda Ramírez OA, Catalán V, Caviedes J, Cayetano L, Ceresoli M, Chan M, Chan V, Chandrasinghe P, Chapman S, Chaturvedi A, Chaudhry D, Chaudry H, Chen HW, Cheng A, Chernykh M, Cheruiyot I, Cheung J, Chia C, Chica J, Chinai N, Chirwa A, Chiwaligo J, Choi A, Choi J, Chowdhury MR, Christopher E, Christou N, Chu T, Chua D, Chua HW, Chung C, Cihat Yildirim A, Cillo M, Cioffi S, Claireaux H, Clermonts S, Clifford R, Climent M, Clynch A, Coelen RJ, Colás-Ruiz E, Collar A, Collard M, Connelly T, Connor K, Correia de Sá T, Coşgun Acar N, Costa T, Couch D, Cowper S, Creavin B, Crook B, Curell A, D’alessio R, Dale J, Damgaard Eriksen J, Dario Martin Gonzalez I, Darwish A, Das M, Das R, Das K, Dave R, David SO, Davies T, 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Jariod-Ferrer Ú, Javanmard H, Javed S, Jayarajah U, Jayasuriya I, Je J, Jessop Z, Jia Lin Tang E, Jiang H, Jiayan Y, Jih Huei T, Jimenez-Rodriguez R, Joh D, Johnson A, Jones N, Jones C, Jordan C, José J, José Núñez Ju J, José Pizarro M, Jose Salazar C, Joseph J, Joseph J, Justiniano C, Kabir T, Kalfountzos C, Kalogiannaki E, Kalyanasundaram K, Kamarajah S, Kamil Quraishi M, Kapila A, Kapila V, Karagiannidis G, Kashif M, Kathiravelupillai S, Kathiravelupillai A, Katsogridakis E, Kaur K, Kaur Sekhon Inderjit Singh H, Kausur N, Kawka M, Keehan G, Kehlet Watt S, Kelly M, Kelvin Egbuchulem I, Kembuan G, Khajeh E, Khaled Elfaitur A, Khan MF, Khan S, Khan M, Khan D, Khan H, Khatkar H, Khaw R, Kim B, Kishore Siddiraju K, Kitua D, Kırımtay B, Kmezić S, Knight S, Knight S, Koëter T, Koh A, Koh Hong Xiang F, Kojo Anyomih T, Kokelaar R, Koliarakis I, Kolli S, Kong J, Kong J, König D, Koshy M, Kourdouli A, Kowal M, Kraima A, Kramer F, Kryzauskas M, Kuchynskyi I, Kuemmerli C, Kuiper S, Kumar S, Kumar A, Kumar A, Kumar L, Kumar H, Kumar N, Kumar S, Kumar Bandyopadhyay S, Kumar Garg P, Kumar Venkatappa S, Kung J, Kural S, Kushairi A, Kuuzie E, Kvietkauskas M, Kwek I, La J, Lai L, Lakpriya S, Lam K, Lami M, Lapolla P, Larsen H, Latif J, Laudari U, Laurnezi A, Lawal A, Lawday S, Lederhuber H, Lednev A, Lee R, Lee R, Lefevbre G, Lesmus M, Leyva Moraga FA, Leyva Moraga E, Leyva Moraga F, Li HL, Li Z, Licardie E, Light A, Lin A, Lincango E, Litta F, Liu H, Lofthouse B, Londoño MA, Lopes R, Lopes de Freitas R, Lopez L, López AI, Lopez-Gomez J, Lopez-Pena G, Lowe R, Lowe D, Lowey M, Loy G, Lozanovski V, Luzon J, Lynn P, Maccabe T, Machielsen A, Mafla Herrería CA, Maggino L, Mahmood D, Mahmoud M, Mahtani K, Maitra I, Maji S, Majiet I, Mal L, Mal L, Malherbe J, Malhotra K, Malkomes P, Man E, Manan Sheikh A, Manjunath S, Manzano Nuñez R, Manzoor S, Maqsood R, Marchegiani G, Marchegiani G, Marchegiani F, Marín D, Marin A, Marks I, Marks I, Marson E, Martensen A, Martin D, Martín Martín G, Martin-Perez B, Martinez P, Marwaha P, Mashauri C, Mashbari H, Masior Ł, Masri R, Masud L, Masudi S, Mateu Calabuig G, Math S, Matrachisia A, Mazingi D, Mazzotta A, McAlinden J, McCabe G, McColm L, McElvaney H, McGivern K, McGovern J, McGuinness E, McInerney N, Mckay S, McKee C, McKenna M, McKenna N, McLean K, Mediratta S, Medkova Y, Medzhidov O, Mehraj A, Mekhael M, Mekinde O, Mellenthin C, Melucci A, Mentor K, Merchant J, Messias H, Meza C, Mhango P, Miladinov M, Milagros Niquen Jimenez M, Miller P, Mills E, Milton A, Mischlinger H, Möckli B, Modi R, Mohamed HM, Mohamed M, Mohamed Abulghasm T, Mohammad SA, Mohammed TO, Mohammed A, Mohan H, Mohan M, Moin I, Mok V, Molina G, Moloney J, Moneim J, Monfort Mira M, Montcusí Ventura B, Montouri M, Moossdorff M, Mora-Guzmán I, Moran B, Morán RAR, Moreno-Ordaz S, Morera Á, Morgan R, Morley R, Moro-Valdezate D, Moros S, Moss JL, Moynihan A, Moyón M, Muduli N, Mugla N, Mugla W, Müller P, Mun G, Mundhada R, Munir I, Muñoz F, Muñoz E, Muñoz A, Muñoz Balderas DC, Murgitroyd E, Murray V, Murthy S, Mushiwokufa W, Mustafa H, Mustakimov B, Mutambanengwe P, Myint P, Nadkarni S, Nadkarni S, Nahar S, Naidoo P, Nam R, Nandhra S, Nanjappa N, Narasimhan V, Nardi W, Nasir M, Nasir M, Naughton A, Naumann D, Navarro S, Nawaaz Karimbocus M, Nazir A, Ndereya S, Ndong A, Negoi I, Nel D, Nelson D, Nepal S, Neufeld J, Ng J, Ng J, Ng D, Ng CE, Ng J, Ngaserin S, Ngu L, Ngwenya E, Fhearaigh RN, Nikolousakis TK, Ninkovic M, Nita G, Nitschke C, Noren E, Noton T, Novikova A, Nowinka Z, Nyakunengwa T, Nyalundja A, Nzenwa I, Kristensen HØ, O’Brien L, O’Brien S, O’Reilly J, O’Rourke S, O’Sullivan M, O’Dwyer M, Ochieng L, Oderoha E, Oh KE, Öhlberger L, Ölçüm M, Olkina A, Omkumar M, Omnitel B, Oncel Yakar D, Ong K, Ong Wei Lin L, Ooi R, Ooi S, Oomman A, Oon Tyjet D, Opiyo S, Oscullo Yepez JJ, Osei-kuffour N, Osunronbi T, Ottlakán A, Oussama Kacimi S, Ovaere S, Ozair A, Pachler F, Pai Oo S, Paiella S, Panaiotti L, Panda N, Pandarinath S, Pandey D, Pandrowala S, Pandrowala S, Papa Mamadou F, Paranathala M, Park J, Parmar C, Parvez A, Pasovic L, Pasquer A, Pasumarthy N, Pata F, Patel T, Patel P, Patel N, Patel M, Patel P, Patron Uriburu N, Patrone R, Paul A, Pavan Kumar OM, Pavithran A, Pedraza Ciro M, Peloso A, Peña Gallardo MT, Peña Velazquez A, Perea J, Pérez-Sánchez LE, Perra T, Perrotta G, Petersson P, Petra G, Petrucciani N, Pickin C, Pino V, Pinotti E, Pinto F, Plum P, Podesta F, Pollini T, Pompeu Sá M, Ponce Leon F, Ponniah HS, Ponte de Sousa X, Ponton J, Pontula A, Popa M, Portilla AL, Posner F, Potolicchio A, Pouwels S, Povo A, Prasad P, Preciado S, Preece R, Proud D, Pulido Segura JA, Puliyath N, Qui M, Quimbaya Rodríguez AS, Raby-Smith W, Racoviţă A, Radwan R, Rafaih Iqbal M, Rafik A, Raguan B, Rahi M, Rahiri JL, Rahme J, Rai L, Raj A, Raj Saksena A, Raja M, Ramirez J, Ramzi J, Rao C, Rashid A, Ratnayake B, Rattanasirivilai K, Raubenheimer K, Ravikumar N, Ravn S, Razoz N, Rea W, Regan A, Rela M, Remme A, Rey Chaves CE, Reyes A, Riad A, Rice D, Rios Quintana K, Ritter A, Roalsø M, Robinson D, Rodriguez J, Rodríguez F, Rodriguez MC, Rogers A, Rohila J, Romanyuc D, Romic I, Rommaneh M, Rompianesi G, Rosa F, Roscio F, Rose A, Rotimi T, Ruiz H, Ruiz Yucuma J, Ruiz-Úcar E, Ruslan M, Rutegård M, Ryan Harper E, Ryckx A, Rydbeck D, Sá-Marta E, Sadien I, Safari Nteranya D, Sagoo K, Sakata S, Saladino E, Saleem A, Saleem S, Salehi M, Salih S, Sallinen V, Salvans S, Sam ZH, Samadov E, Emile SH, Sampaio Alves M, Sanad A, Sánchez Fonseca S, Sanchez Teran A, Sanchez Ussa S, Sanchez Ussa S, Sandli O, Sanghera J, Sani I, Santafe Guerrero M, Sante Fornasiero M, Santes Jasso O, Santos Pereira I, Santos Sousa H, Saratzis A, Sarmiento Alarcon A, Saumtally T, Sayyed R, Schettino M, Schleimer L, Schmidt T, Schondffelt K, Schwab M, Scott A, Searle H, Sebopelo L, Seeglier B, Seishima R, Semenvov D, Senent-Boza A, Sepulveda J, Serenari M, Serrano Navidad M, Sert I, Sewart E, Sgrò A, Shadrina V, Shah K, Shahid F, Shalaby M, Shankar B, Shapiro J, Sharma L, Sheel A, Shenfine A, Shenoy S, Sherif A, Shetty N, Shetty R, Sia TC, Sichimba D, Siddique H, Siddiqui I, Simkens G, Simon H, Sinan L, Singh T, Singh K, Singh Y, Sinha L, Siragusa L, Sluckin T, Smart YW, Smith H, Smits L, Sneep-van Kessel C, Sohrabi C, Solórzano Pineda O, Soma A, Sooriyapiragasam L, Sparavigna M, Spence R, Spencer N, Spiers H, Sprakel J, Sravanam S, Srinivasan M, Srinivasan R, Staniszewska A, Stasinos K, Steinholt I, Steinruecke M, Stephen BJ, Stijns J, Still M, Stupalkowska W, Subba S, Sucharitkul P, Sudarsanam A, Sudhamsh Reddy D, Suhardja T, Suliman M, Sunilkumar A, Suresh N, Sussmes S, Sutton P, Syltern J, Taha A, Takamizawa Y, Takoutsing Dongmo AB, Tamás T, Tan L, Tan JL, Tan K, Tan E, Tan Yong Hui A, Tanase A, Tariverdiev A, Tasnem A, Tatar C, Tay E, Tejedor P, Tesfaye G, Tetinou F, Thorpe C, Thyø A, Tlelo Amastal D, Tolani M, Tolga Saracoglu K, Tölgyes T, Torrent Jansà L, Toscano Igartua S, Tovani Palone MR, Traff H, Trevis J, Tummers W, Tur A, Turchenko I, Uche V, Uddin A, Udonsak N, Ullah M, Urbonas T, Uwins C, Uy Magadia E, Uzair Qureshi A, Uzun K, Vadim P, Valarche G, Valdez Gonzalez RA, van Beek DJ, van Dalen AS, van den Hondel D, van der stok E, van Dorp M, van Oostendorp S, van Praag E, van Rees J, van Silfhout L, Varga Z, Varghese S, Varghese C, Varghese J, Vasilica AM, Vásquez Ojeda X, Vega E, Vehler S, Venchiarutti R, Vengatesan S, Venn M, Verma D, Vianey Partida Nava G, Victoria D, Vieira P, Vilar Alvarez ME, Vinci D, Viscasillas Pallàs G, Viswanath M, Vivanco J, Vizcaya Rodríguez V, Vo J, Volchanski D, Voron T, Voronovskyi Y, Vu J, Wadhwa M, Wadhwa S, Wagner G, Wallace M, Wang YY, Wang J, Wani A, Wanigasooriya K, Wanjara S, Wanjiku N, Warner C, Wei Leow T, Wellington MJ, Wells C, Wenzelberg C, Wettstein D, Wezel A, Wheldon L, Widmer L, Wijayaratne T, Wijeyaratne M, Wilkin R, Williams E, Willis F, Winter D, Wirsik MM, Wishah B, Wong G, Wong WJ, Wong K, Wong KY, Worku D, Wright E, Wright J, Wright J, Wright OW, Xenacki S, Xia W, Xu W, Xu Z, Yalcinkaya A, Yang W, Yang PC, Yanishev A, Yanzon de la Torre A, Yao H, Yaqoob E, Yen Ling Quake S, Yeo D, Yeom B, Yershov D, Yiasemidou M, Yildiz A, Yiu A, Yong E, Yoshimura R, Younis MU, Younis Ringshawl Z, Youssef M, Yue Y, Yuen S, Yuldashev R, Yurttas C, Yves B, Zaborowski A, Zackeri R, Zafar A, Zahra W, Zaidi A, Zainudin S, Zakeri R, Zamora I, Zamora AT, Zawistowski M, Zbikowska G, Zegers W, Zehra S, Zeyra A, Zhagniyev Z, Zivanovic M, Zmuc J, Zope M, Zubayraeva A, Zucker B. BJS commission on surgery and perioperative care post-COVID-19. Br J Surg 2021; 108:1162-1180. [PMID: 34624081 DOI: 10.1093/bjs/znab307] [Show More Authors] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues' experiences and published evidence. METHODS In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. RESULTS BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. CONCLUSION The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era.
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MESH Headings
- Adult
- Biomedical Research/organization & administration
- COVID-19/diagnosis
- COVID-19/economics
- COVID-19/epidemiology
- COVID-19/prevention & control
- Education, Medical, Graduate/methods
- Education, Medical, Graduate/trends
- Female
- Global Health
- Health Resources/supply & distribution
- Health Services Accessibility/trends
- Humans
- Infection Control/economics
- Infection Control/methods
- Infection Control/standards
- International Cooperation
- Male
- Middle Aged
- Pandemics
- Perioperative Care/education
- Perioperative Care/methods
- Perioperative Care/standards
- Perioperative Care/trends
- Practice Patterns, Physicians'/standards
- Practice Patterns, Physicians'/trends
- Surgeons/education
- Surgeons/psychology
- Surgeons/trends
- Surgical Procedures, Operative/education
- Surgical Procedures, Operative/methods
- Surgical Procedures, Operative/standards
- Surgical Procedures, Operative/trends
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Ahmadian E, Zununi Vahed S, Mammadova S, Abediazar S. Immunosuppressant Management in Renal Transplant Patients with COVID-19. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9318725. [PMID: 34692845 PMCID: PMC8531766 DOI: 10.1155/2021/9318725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/31/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic poses a special risk for both immunosuppressed patients, especially transplant recipients. Although the knowledge about this infection is growing, many uncertainties remain, particularly regarding the kidney. Kidney transplant recipients (KDRs) should be considered immunocompromised hosts since a potential risk for infection, comorbidity, and immunosuppression exposure exists. Additionally, the management of immunosuppressive agents in KDRs remains challenging. Potential drug interactions with immunosuppressive treatment escalated the risk of unwanted side effects. In this review, we aimed to attain an augmented awareness and improved management immunosuppressant for COVID-19 KDRs.
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Affiliation(s)
- Elham Ahmadian
- Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Shakar Mammadova
- Department of Physical Geography, Baku State University, Baku, Azerbaijan
| | - Sima Abediazar
- Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Wang X, Lei J, Li Z, Yan L. Potential Effects of Coronaviruses on the Liver: An Update. Front Med (Lausanne) 2021; 8:651658. [PMID: 34646834 PMCID: PMC8502894 DOI: 10.3389/fmed.2021.651658] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
The coronaviruses that cause notable diseases, namely, severe acute respiratory syndrome (SARS), middle east respiratory syndrome (MERS) and coronavirus disease 2019 (COVID-19), exhibit remarkable similarities in genomic components and pathogenetic mechanisms. Although coronaviruses have widely been studied as respiratory tract pathogens, their effects on the hepatobiliary system have seldom been reported. Overall, the manifestations of liver injury caused by coronaviruses typically involve decreased albumin and elevated aminotransferase and bilirubin levels. Several pathophysiological hypotheses have been proposed, including direct damage, immune-mediated injury, ischemia and hypoxia, thrombosis and drug hepatotoxicity. The interaction between pre-existing liver disease and coronavirus infection has been illustrated, whereby coronaviruses influence the occurrence, severity, prognosis and treatment of liver diseases. Drugs and vaccines used for treating and preventing coronavirus infection also have hepatotoxicity. Currently, the establishment of optimized therapy for coronavirus infection and liver disease comorbidity is of significance, warranting further safety tests, animal trials and clinical trials.
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Affiliation(s)
- Xinyi Wang
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
- Liver Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jianyong Lei
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
- Liver Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Zhihui Li
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
- Liver Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Lunan Yan
- Liver Surgery Center, West China Hospital of Sichuan University, Chengdu, China
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Raevens S, Boret M, De Pauw M, Fallon MB, Van Vlierberghe H. Pulmonary Abnormalities in Liver Disease: Relevance to Transplantation and Outcome. Hepatology 2021; 74:1674-1686. [PMID: 33636019 DOI: 10.1002/hep.31770] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/17/2021] [Accepted: 02/08/2021] [Indexed: 12/14/2022]
Abstract
Pulmonary disease in liver cirrhosis and portal hypertension (PH) constitutes a challenging clinical scenario and may have important implications with regard to prognosis, liver transplantation (LT) candidacy, and post-LT outcome. Pre-LT evaluation should include adequate screening for pulmonary diseases that may occur concomitantly with liver disease as well as for those that may arise as a complication of end-stage liver disease and PH, given that either may jeopardize safe LT and successful outcome. It is key to discriminate those patients who would benefit from LT, especially pulmonary disorders that have been reported to resolve post-LT and are considered "pulmonary indications" for transplant, from those who are at increased mortality risk and in whom LT is contraindicated. In conclusion, in this article, we review the impact of several pulmonary disorders, including cystic fibrosis, alpha 1-antitrypsin deficiency, hereditary hemorrhagic telangiectasia, sarcoidosis, coronavirus disease 2019, asthma, chronic obstructive pulmonary disease, pulmonary nodules, interstitial lung disease, hepatic hydrothorax, hepatopulmonary syndrome, and portopulmonary hypertension, on post-LT survival, as well as the reciprocal impact of LT on the evolution of lung function.
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Affiliation(s)
- Sarah Raevens
- Department of Gastroenterology and Hepatology, Ghent University-Ghent University Hospital, Ghent, Belgium
| | - Maxine Boret
- Department of Gastroenterology and Hepatology, Ghent University-Ghent University Hospital, Ghent, Belgium
| | - Michel De Pauw
- Department of Cardiology, Ghent University-Ghent University Hospital, Ghent, Belgium
| | - Michael B Fallon
- Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, AZ
| | - Hans Van Vlierberghe
- Department of Gastroenterology and Hepatology, Ghent University-Ghent University Hospital, Ghent, Belgium
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15
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Mohamed DZ, Ghoneim MES, Abu-Risha SES, Abdelsalam RA, Farag MA. Gastrointestinal and hepatic diseases during the COVID-19 pandemic: Manifestations, mechanism and management. World J Gastroenterol 2021; 27:4504-4535. [PMID: 34366621 PMCID: PMC8326263 DOI: 10.3748/wjg.v27.i28.4504] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/12/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered the causative pathogen of coronavirus disease 2019 (COVID-19) and has become an international danger to human health. Although respiratory transmission and symptoms are still the essential manifestations of COVID-19, the digestive system could be an unconventional or supplementary route for COVID-19 to be transmitted and manifested, most likely due to the presence of angiotensin-converting enzyme 2 (ACE2) in the gastrointestinal tract. In addition, SARS-CoV-2 can trigger hepatic injury via direct binding to the ACE2 receptor in cholangiocytes, antibody-dependent enhancement of infection, systemic inflammatory response syndrome, inflammatory cytokine storms, ischemia/reperfusion injury, and adverse events of treatment drugs. Gastrointestinal symptoms, including anorexia, nausea, vomiting, and diarrhea, which are unusual in patients with COVID-19, and some digestive signs may occur without other respiratory symptoms. Furthermore, SARS-CoV-2 can be found in infected patients' stool, demonstrating the likelihood of transmission through the fecal-oral route. In addition, liver function should be monitored during COVID-19, particularly in more severe cases. This review summarizes the evidence for extra-pulmonary manifestations, mechanisms, and management of COVID-19, particularly those related to the gastrointestinal tract and liver.
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Affiliation(s)
- Dina Zakaria Mohamed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Tanta 31511, Egypt
| | - Mai El-Sayed Ghoneim
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Sadat City, Menoufia 32632, Egypt
| | - Sally El-Sayed Abu-Risha
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Tanta 31511, Egypt
| | - Ramy Ahmed Abdelsalam
- Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt
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16
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Fancellu A, Sanna V, Scognamillo F, Feo CF, Vidili G, Nigri G, Porcu A. Surgical treatment of hepatocellular carcinoma in the era of COVID-19 pandemic: A comprehensive review of current recommendations. World J Clin Cases 2021; 9:3517-3530. [PMID: 34046452 PMCID: PMC8130078 DOI: 10.12998/wjcc.v9.i15.3517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/02/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023] Open
Abstract
The new coronavirus disease 2019 (COVID-19) pandemic has resulted in a global health emergency that has also caused profound changes in the treatment of cancer. The management of hepatocellular carcinoma (HCC) across the world has been modified according to the scarcity of care resources that have been diverted mostly to face the surge of hospitalized COVID-19 patients. Oncological and hepatobiliary societies have drafted recommendations regarding the adaptation of guidelines for the management of HCC to the current healthcare situation. This review focuses on specific recommendations for the surgical treatment of HCC (i.e., hepatic resection and liver transplantation), which still represents the best chance of cure for patients with very early and early HCC. While surgery should be pursued for very selected patients in institutions where standards of care are maintained, alternative or bridging methods, mostly thermoablation and transarterial therapies, can be used until surgery can be performed. The prognosis of patients with HCC largely depends on both the characteristics of the tumour and the stage of underlying liver disease. Risk stratification plays a pivotal role in determining the most appropriate treatment for each case and needs to balance the chance of cure and the risk of COVID-19 infection during hospitalization. Current recommendations have been critically reviewed to provide a reference for best practices in the clinical setting, with adaptation based on pandemic trends and categorization according to COVID-19 prevalence.
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Affiliation(s)
- Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Valeria Sanna
- Unit of Medical Oncology, AOU Sassari, Sassari 07100, Italy
| | - Fabrizio Scognamillo
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 1 - Patologia Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Claudio F Feo
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, Unit of Internal Medicine, University of Sassari, Sassari 07100, Italy
| | - Giuseppe Nigri
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, St. Andrea University Hospital, Rome 00189, Italy
| | - Alberto Porcu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
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17
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Wu J, Xiong L, Li P. Coronavirus disease 2019 (COVID-19) in a Chinese renal transplant recipient: a case report. Transl Androl Urol 2021; 10:2140-2148. [PMID: 34159095 PMCID: PMC8185678 DOI: 10.21037/tau-21-314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Since December 2019, a novel coronavirus that caused viral pneumonia broke out and became global pandemic. Coronavirus disease 2019 (COVID-19) is caused by the SARS-CoV-2 virus. Reports on the clinical manifestations in solid organ transplant (SOT) recipients are rare. We report the clinical features and treatment of a Chinese renal transplant recipient with COVID-19. A 46-year-old Chinese woman, who had a renal transplant in 2006 due to chronic glomerulonephritis, was admitted to Renmin Hospital of Wuhan University for fever, cough, and expectoration for more than 10 days and diarrhea for 3 days. At admission, her body temperature was 38.2 °C and pulse oxygen saturation was 96% under oxygen inhalation. There were decreased breath sounds bilaterally. Laboratory data revealed normal leucocyte count, a normal percentage of neutrophils, a normal percentage of lymphocytes, decreased lymphocyte count, elevated procalcitonin and C-reactive protein (CRP), and increased levels of urea, creatinine, and estimated glomerular filtration rate. COVID-19 was confirmed by nasopharyngeal swab and sputum which were positive for SARS-CoV-2 by real-time reverse transcription PCR (RT-PCR). Chest CT revealed multiple patchy and flake ground-glass shadows in bilateral lung fields, and strip shadows in bilateral lower lobes. Treatment included antiviral (umifenovir, hydroxychloroquine), antibacterial (moxifloxacin), and other support therapies. Her symptoms, laboratory data, and chest CT showed trends of gradual improvement, while nasopharyngeal swabs were always positive for SARS-CoV-2. She was finally discharged from hospital on her 70th day of hospitalization when 2 consecutive nasopharyngeal swabs were negative for SARS-CoV-2. This is a rare report on COVID-19 in a renal transplant recipient, which can help enhance the understanding and treatment of COVID-19 in renal transplant recipients.
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Affiliation(s)
- Jian Wu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liangkun Xiong
- Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Peng Li
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
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18
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Arya A, Li M, Aburjania N, Singh P, Royer T, Moss S, Belden KA. COVID-19 in Solid Organ Transplantation: Disease Severity and Clinical Update. Transplant Proc 2021; 53:1227-1236. [PMID: 33757628 PMCID: PMC7904466 DOI: 10.1016/j.transproceed.2021.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/13/2021] [Accepted: 02/21/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Solid organ transplant (SOT) recipients are a complex, immunocompromised population in whom greater coronavirus disease 2019 (COVID-19) mortality has been reported compared with the general population. METHODS We examined a retrospective cohort of 58 SOT recipients with first-wave COVID-19, comparing patients with severe and nonsevere illness. Additionally, SOT recipients are compared with general patients with first-wave COVID-19. RESULTS Organs transplanted included 38 kidneys, 8 livers, 5 hearts, and 3 pancreases. Average SOT recipient age was 57.4 years; 62% were male; 46.6% were African American 36.2% were white. Comorbidities included hypertension (86%), chronic kidney disease (86%), diabetes mellitus (50%), coronary artery disease (26%), and chronic obstructive pulmonary disease (14%). Twenty patients had severe COVID-19 (34.5%) and 38 had nonsevere disease (65.5%). Severe disease was more common in older SOT recipients with comorbidities and was associated with cough, dyspnea, pneumonia, C-reactive protein >10 mg/L, and platelet count <150/μL. Sex, race, body mass index, time from transplant, baseline immunosuppression, and diagnosis month did not differ among those with severe and nonsevere COVID-19. Seventy percent of SOT recipients were hospitalized vs 27.2% of general patients with COVID-19 and inpatient SOT recipients had a higher mechanical ventilation rate. Though a trend toward longer length of stay, higher intensive care unit admission, and greater inpatient mortality was observed (19.5% vs 14.8%), these differences were not significant. CONCLUSIONS The severe acute respiratory syndrome coronavirus 2 has greatly impacted SOT recipients. One-third of our SOT recipients seen during the first wave had severe illness with associated standard risk factors for poor outcome. Compared with general first-wave patients, more SOT recipients were hospitalized, although inpatient COVID-19 mortality did not significantly differ.
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Affiliation(s)
- Akanksha Arya
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Michael Li
- Enterprise Analytics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Nana Aburjania
- Department of Medicine/Infectious Diseases, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Pooja Singh
- Department of Nephrology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tricia Royer
- Department of Medicine/Infectious Diseases, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sean Moss
- Department of Medicine/Infectious Diseases, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Katherine A Belden
- Department of Medicine/Infectious Diseases, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
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19
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Coll E, Fernández-Ruiz M, Sánchez-Álvarez JE, Martínez-Fernández JR, Crespo M, Gayoso J, Bada-Bosch T, Oppenheimer F, Moreso F, López-Oliva MO, Melilli E, Rodríguez-Ferrero ML, Bravo C, Burgos E, Facundo C, Lorenzo I, Yañez Í, Galeano C, Roca A, Cabello M, Gómez-Bueno M, García-Cosío M, Graus J, Lladó L, de Pablo A, Loinaz C, Aguado B, Hernández D, Domínguez-Gil B, the Spanish Group for the Study of COVID-19 in Transplant Recipients. COVID-19 in transplant recipients: The Spanish experience. Am J Transplant 2021; 21:1825-1837. [PMID: 33098200 PMCID: PMC9906239 DOI: 10.1111/ajt.16369] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023]
Abstract
We report the nationwide experience with solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients diagnosed with coronavirus disease 2019 (COVID-19) in Spain until 13 July 2020. We compiled information for 778 (423 kidney, 113 HSCT, 110 liver, 69 heart, 54 lung, 8 pancreas, 1 multivisceral) recipients. Median age at diagnosis was 61 years (interquartile range [IQR]: 52-70), and 66% were male. The incidence of COVID-19 in SOT recipients was two-fold higher compared to the Spanish general population. The median interval from transplantation was 59 months (IQR: 18-131). Infection was hospital-acquired in 13% of cases. No donor-derived COVID-19 was suspected. Most patients (89%) were admitted to the hospital. Therapies included hydroxychloroquine (84%), azithromycin (53%), protease inhibitors (37%), and interferon-β (5%), whereas immunomodulation was based on corticosteroids (41%) and tocilizumab (21%). Adjustment of immunosuppression was performed in 85% of patients. At the time of analysis, complete follow-up was available from 652 patients. Acute respiratory distress syndrome occurred in 35% of patients. Ultimately, 174 (27%) patients died. In univariate analysis, risk factors for death were lung transplantation (odds ratio [OR]: 2.5; 95% CI: 1.4-4.6), age >60 years (OR: 3.7; 95% CI: 2.5-5.5), and hospital-acquired COVID-19 (OR: 3.0; 95% CI: 1.9-4.9).
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Affiliation(s)
- Elisabeth Coll
- Organización Nacional de Trasplantes (Spanish National Transplant Organization), Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre. Instituto de Investigación Sanitaria, Hospital Universitario 12 de Octubre (imas12), President of the Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain
- Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain
| | - J. Emilio Sánchez-Álvarez
- Department of Nephrology, Hospital Universitario de Cabueñes, Gijón, Spain
- Spanish Society of Nephrology (SEN), Gijón, Spain
| | | | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
- Transplant Working Group of the Spanish Society of Nephrology (SEN), Barcelona, Spain
- REDinREN (RD16/0009/0013), Barcelona, Spain
| | - Jorge Gayoso
- Organización Nacional de Trasplantes (Spanish National Transplant Organization), Madrid, Spain
| | - Teresa Bada-Bosch
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Francesc Moreso
- Kidney Transplant Unit, Department of Nephrology, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
| | | | - Edoardo Melilli
- Kidney Transplant Unit, Department of Nephrology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - Carlos Bravo
- Department of Pulmonology, Lung transplant Unit, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
| | - Elena Burgos
- Department of Nephrology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Carme Facundo
- Kidney Transplant Unit, Fundación Puigvert, Barcelona, Spain
| | - Inmaculada Lorenzo
- Department of Nephrology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Íñigo Yañez
- Department of Nephrology, Hospital Universitario de Cruces, Barakaldo, Spain
| | - Cristina Galeano
- Kidney Transplant Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Roca
- Department of Nephrology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Mercedes Cabello
- Department of Nephrology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Manuel Gómez-Bueno
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - MaDolores García-Cosío
- Cardiology Service, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Javier Graus
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Laura Lladó
- Liver Transplant Unit, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Alicia de Pablo
- Lung Transplant Unit, Department of Pneumology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carmelo Loinaz
- Transplant Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Beatriz Aguado
- Transplant Unit. Department of Hematology, Hospital Universitario La Princesa, Madrid, Spain
| | - Domingo Hernández
- Department of Nephrology, Hospital Regional Universitario, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Spanish Society of Transplantation (SET), Málaga, Spain
| | - Beatriz Domínguez-Gil
- Organización Nacional de Trasplantes (Spanish National Transplant Organization), Madrid, Spain
| | - the Spanish Group for the Study of COVID-19 in Transplant Recipients
- Organización Nacional de Trasplantes (Spanish National Transplant Organization), Madrid, Spain
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre. Instituto de Investigación Sanitaria, Hospital Universitario 12 de Octubre (imas12), President of the Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain
- Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain
- Department of Nephrology, Hospital Universitario de Cabueñes, Gijón, Spain
- Spanish Society of Nephrology (SEN), Gijón, Spain
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
- Transplant Working Group of the Spanish Society of Nephrology (SEN), Barcelona, Spain
- REDinREN (RD16/0009/0013), Barcelona, Spain
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Department of Nephrology, Hospital Clinic, Barcelona, Spain
- Kidney Transplant Unit, Department of Nephrology, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
- Department oof Nephrology, Hospital Universitario La Paz, Madrid, Spain
- Kidney Transplant Unit, Department of Nephrology, Hospital Universitario de Bellvitge, Barcelona, Spain
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of Pulmonology, Lung transplant Unit, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
- Department of Nephrology, Hospital Germans Trias i Pujol, Badalona, Spain
- Kidney Transplant Unit, Fundación Puigvert, Barcelona, Spain
- Department of Nephrology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- Department of Nephrology, Hospital Universitario de Cruces, Barakaldo, Spain
- Kidney Transplant Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Department of Nephrology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
- Department of Nephrology, Hospital Regional Universitario de Málaga, Málaga, Spain
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
- Cardiology Service, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Liver Transplant Unit, Hospital Universitario de Bellvitge, Barcelona, Spain
- Lung Transplant Unit, Department of Pneumology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Transplant Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario 12 de Octubre, Madrid, Spain
- Transplant Unit. Department of Hematology, Hospital Universitario La Princesa, Madrid, Spain
- Department of Nephrology, Hospital Regional Universitario, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Spanish Society of Transplantation (SET), Málaga, Spain
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20
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Coiffard B, Lepper PM, Prud’Homme E, Daviet F, Cassir N, Wilkens H, Hraiech S, Langer F, Thomas PA, Reynaud-Gaubert M, Bals R, Schäfers HJ, Papazian L, Seiler F. Management of lung transplantation in the COVID-19 era-An international survey. Am J Transplant 2021; 21:1586-1596. [PMID: 33084144 PMCID: PMC9906357 DOI: 10.1111/ajt.16368] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/16/2020] [Accepted: 10/16/2020] [Indexed: 01/25/2023]
Abstract
It is unknown if solid organ transplant recipients are at higher risk for severe COVID-19. The management of a lung transplantation (LTx) program and the therapeutic strategies to adapt the immunosuppressive regimen and antiviral measures is a major issue in the COVID-19 era, but little is known about worldwide practice. We sent out to 180 LTx centers worldwide in June 2020 a survey with 63 questions, both regarding the management of a LTx program in the COVID-19 era and the therapeutic strategies to treat COVID-19 LTx recipients. We received a total of 78 responses from 15 countries. Among participants, 81% declared a reduction of the activity and 47% restricted LTx for urgent cases only. Sixteen centers observed deaths on waiting listed patients and eight centers performed LTx for COVID-19 disease. In 62% of the centers, COVID-19 was diagnosed in LTx recipients, most of them not severe cases. The most common immunosuppressive management included a decreased dose or pausing of the cell cycle inhibitors. Remdesivir, hydroxychloroquine, and azithromycin were the most proposed antiviral strategies. Most of the centers have been affected by the COVID-19 pandemic and proposed an active therapeutic strategy to treat LTx recipients with COVID-19.
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Affiliation(s)
- Benjamin Coiffard
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille Univ, APHM, Hôpital Nord, Marseille, France
| | - Philipp M. Lepper
- Department of Internal Medicine V – Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Eloi Prud’Homme
- Aix Marseille Univ, APHM, Hôpital Nord, Intensive Care Unit, Marseille, France
| | - Florence Daviet
- Aix Marseille Univ, APHM, Hôpital Nord, Intensive Care Unit, Marseille, France
| | - Nadim Cassir
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Heinrike Wilkens
- Department of Internal Medicine V – Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Sami Hraiech
- Aix Marseille Univ, APHM, Hôpital Nord, Intensive Care Unit, Marseille, France
| | - Frank Langer
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
| | - Pascal A. Thomas
- Department of Thoracic Surgery, Aix Marseille Univ, APHM, Hôpital Nord, Marseille, France
| | - Martine Reynaud-Gaubert
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille Univ, APHM, Hôpital Nord, Marseille, France
| | - Robert Bals
- Department of Internal Medicine V – Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
| | - Laurent Papazian
- Aix Marseille Univ, APHM, Hôpital Nord, Intensive Care Unit, Marseille, France
| | - Frederik Seiler
- Department of Internal Medicine V – Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
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21
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Chang AY, Cullen MR, Harrington RA, Barry M. The impact of novel coronavirus COVID-19 on noncommunicable disease patients and health systems: a review. J Intern Med 2021; 289:450-462. [PMID: 33020988 PMCID: PMC7675448 DOI: 10.1111/joim.13184] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic affecting all levels of health systems. This includes the care of patients with noncommunicable diseases (NCDs) who bear a disproportionate burden of both COVID-19 itself and the public health measures enacted to combat it. In this review, we summarize major COVID-19-related considerations for NCD patients and their care providers, focusing on cardiovascular, pulmonary, renal, haematologic, oncologic, traumatic, obstetric/gynaecologic, operative, psychiatric, rheumatologic/immunologic, neurologic, gastrointestinal, ophthalmologic and endocrine disorders. Additionally, we offer a general framework for categorizing the pandemic's disruptions by disease-specific factors, direct health system factors and indirect health system factors. We also provide references to major NCD medical specialty professional society statements and guidelines on COVID-19. COVID-19 and its control policies have already resulted in major disruptions to the screening, treatment and surveillance of NCD patients. In addition, it differentially impacts those with pre-existing NCDs and may lead to de novo NCD sequelae. Likely, there will be long-term effects from this pandemic that will continue to affect practitioners and patients in this field for years to come.
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Affiliation(s)
- Andrew Y. Chang
- From theDivision of Cardiovascular MedicineStanford UniversityStanfordCAUSA
- Department of MedicineStanford UniversityStanfordCAUSA
- Center for Innovation in Global HealthStanford UniversityStanfordCAUSA
| | - Mark R. Cullen
- Department of MedicineStanford UniversityStanfordCAUSA
- Division of Primary Care and Population HealthStanford UniversityStanfordCAUSA
| | | | - Michele Barry
- Department of MedicineStanford UniversityStanfordCAUSA
- Center for Innovation in Global HealthStanford UniversityStanfordCAUSA
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22
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Phadke VK, Scanlon N, Jordan SC, Rouphael NG. Immune Responses to SARS-CoV-2 in Solid Organ Transplant Recipients. CURRENT TRANSPLANTATION REPORTS 2021; 8:127-139. [PMID: 33688459 PMCID: PMC7931983 DOI: 10.1007/s40472-021-00322-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Coronavirus disease 2019 (COVID-19) is caused by a complex interplay between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dynamics and host immune responses. Hosts with altered immunity, including solid organ transplant recipients, may be at increased risk of complications and death due to COVID-19. A synthesis of the available data on immune responses to SARS-CoV-2 infection is needed to inform therapeutic and preventative strategies in this special population. RECENT FINDINGS Few studies have directly compared immune responses to SARS-CoV-2 between transplant recipients and the general population. Like non-transplant patients, transplant recipients mount an exuberant inflammatory response following initial SARS-CoV2 infection, with IL-6 levels correlating with disease severity in some, but not all studies. Transplant recipients display anti-SARS-CoV-2 antibodies and activated B cells in a time frame and magnitude similar to non-transplant patients-limited data suggest these antibodies can be detected within 15 days of symptom onset and may be durable for several months. CD4+ and CD8+ T lymphopenia, a hallmark of COVID-19, is more profound in transplant recipients, but SARS-CoV-2-reactive T cells can be detected among patients with both mild and severe disease. SUMMARY The limited available data indicate that immune responses to SARS-CoV-2 are similar between transplant recipients and the general population, but no studies have been sufficiently comprehensive to understand nuances between organ types or level of immunosuppression to meaningfully inform individualized therapeutic decisions. The ongoing pandemic provides an opportunity to generate higher-quality data to support rational treatment and vaccination strategies in this population.
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Affiliation(s)
- Varun K. Phadke
- Emory University Vaccine and Treatment Evaluation Unit (VTEU), Division of Infectious Diseases, The Hope Clinic of the Emory Vaccine Center, 500 Irvin Court, Suite 200, Decatur, GA 30030 USA
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Emory University, Decatur, GA USA
| | - Nicholas Scanlon
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Emory University, Decatur, GA USA
| | - Stanley C. Jordan
- Department of Medicine, Division of Nephrology, Transplant Immunology Laboratory, Transplant Immunotherapy Program, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Nadine G. Rouphael
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Emory University, Decatur, GA USA
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Caillard S, Chavarot N, Francois H, Matignon M, Greze C, Kamar N, Gatault P, Thaunat O, Legris T, Frimat L, Westeel PF, Goutaudier V, Jdidou M, Snanoudj R, Colosio C, Sicard A, Bertrand D, Mousson C, Bamoulid J, Masset C, Thierry A, Couzi L, Chemouny JM, Duveau A, Moal V, Blancho G, Grimbert P, Durrbach A, Moulin B, Anglicheau D, Ruch Y, Kaeuffer C, Benotmane I, Solis M, LeMeur Y, Hazzan M, Danion F, the French SOT COVID Registry. Is COVID-19 infection more severe in kidney transplant recipients? Am J Transplant 2021; 21:1295-1303. [PMID: 33259686 PMCID: PMC7753418 DOI: 10.1111/ajt.16424] [Citation(s) in RCA: 192] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 01/25/2023]
Abstract
There are no studies which have compared the risk of severe COVID-19 and related mortality between transplant recipients and nontransplant patients. We enrolled two groups of patients hospitalized for COVID-19, that is, kidney transplant recipients (KTR) from the French Registry of Solid Organ Transplant (n = 306) and a single-center cohort of nontransplant patients (n = 795). An analysis was performed among subgroups matched for age and risk factors for severe COVID-19 or mortality. Severe COVID-19 was defined as admission (or transfer) to an intensive care unit, need for mechanical ventilation, or death. Transplant recipients were younger and had more comorbidities compared to nontransplant patients. They presented with higher creatinine levels and developed more episodes of acute kidney injury. After matching, the 30-day cumulative incidence of severe COVID-19 did not differ between KTR and nontransplant patients; however, 30-day COVID-19-related mortality was significantly higher in KTR (17.9% vs 11.4%, respectively, p = .038). Age >60 years, cardiovascular disease, dyspnea, fever, lymphopenia, and C-reactive protein (CRP) were associated with severe COVID-19 in univariate analysis, whereas transplant status and serum creatinine levels were not. Age >60 years, hypertension, cardiovascular disease, diabetes, CRP >60 mg/L, lymphopenia, kidney transplant status (HR = 1.55), and creatinine level >115 µmol/L (HR = 2.32) were associated with COVID-19-related mortality in univariate analysis. In multivariable analysis, cardiovascular disease, dyspnea, and fever were associated with severe disease, whereas age >60 years, cardiovascular disease, dyspnea, fever, and creatinine level>115 µmol/L retained their independent associations with mortality. KTR had a higher COVID-19-related mortality compared to nontransplant hospitalized patients.
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Affiliation(s)
- Sophie Caillard
- Department of Nephrology and TransplantationStrasbourg University HospitalINSERMUMR‐S 1109StrasbourgFrance
| | - Nathalie Chavarot
- Department of Nephrology and TransplantationHôpital Universitaire NeckerAPHP CenterUniversité de Paris INEM INSERM U 1151CNRS UMR 8253ParisFrance
| | - Hélène Francois
- AP‐HP (Assistance Publique‐Hôpitaux de Paris)Department of Nephrology and TransplantationHopital TenonParisFrance
| | - Marie Matignon
- AP‐HP, Nephrology and Renal Transplantation DepartmentInstitut Francilien de Recherche en Néphrologie et Transplantation (IFRNT)Groupe Hospitalier Henri‐Mondor/Albert‐ChenevierUniversité Paris‐Est‐Créteil, (UPEC)DHU (Département Hospitalo‐Universitaire) VIC (Virus‐Immunité‐Cancer)IMRB (Institut Mondor de Recherche Biomédicale)Equipe 21, INSERM U 955CréteilFrance
| | - Clarisse Greze
- Department of Nephrology and TransplantationHôpital BichatParisFrance
| | - Nassim Kamar
- Department of Nephrology and TransplantationUniversity of ToulouseToulouseFrance
| | - Philippe Gatault
- Department of Nephrology and TransplantationUniversity of ToursToursFrance
| | - Olivier Thaunat
- Department of Transplantation, Nephrology and Clinical ImmunologyHôpital Edouard HerriotHospices Civils de LyonUniversité Claude Bernard Lyon 1LyonFrance
| | - Tristan Legris
- Aix Marseille UniversitéHôpitaux Universitaires de MarseilleHôpital ConceptionCentre de Néphrologie et Transplantation RénaleMarseilleFrance
| | - Luc Frimat
- Department of NephrologyUniversity of LorraineCHRU‐NancyVandoeuvreFrance,INSERM CIC‐EC CIE6NancyFrance
| | - Pierre F. Westeel
- Department of Nephrology and TransplantationUniversity of AmiensAmiensFrance
| | - Valentin Goutaudier
- Department of Nephrology and TransplantationUniversity of MontpellierMontpellierFrance
| | - Mariam Jdidou
- Department of Nephrology and TransplantationHôpital BicêtreLe Kremlin‐BicêtreFrance
| | - Renaud Snanoudj
- Department of Nephrology and TransplantationHôpital BicêtreLe Kremlin‐BicêtreFrance
| | - Charlotte Colosio
- Department of Nephrology and TransplantationUniversity of ReimsReimsFrance
| | - Antoine Sicard
- Department of Nephrology, Dialysis, and TransplantationHopital Pasteur 2C.H.U. de NiceUnité de Recherche Clinique Côte d’Azur (UR2CA)Université Côte d’AzurNiceFrance
| | - Dominique Bertrand
- Department of Nephrology and TransplantationUniversity of RouenRouenFrance
| | - Christiane Mousson
- Department of Nephrology and TransplantationUniversity of DijonDijonFrance
| | - Jamal Bamoulid
- Department of NephrologyUniversity of BesançonBesançonFrance
| | - Christophe Masset
- Department of Nephrology and TransplantationCenter Hospitalier Universitaire de NantesNantesFrance
| | - Antoine Thierry
- Department of NephrologyUniversity of PoitiersPoitiersFrance
| | - Lionel Couzi
- Department of Nephrology‐Transplantation‐Dialysis‐ApheresisHôpital PellegrinCHU de Bordeaux PellegrinUnité Mixte de Recherche “ImmunoConcEpT” 5164 − Université de BordeauxBordeauxFrance
| | - Jonathan M. Chemouny
- University of RennesCHU RennesInsermEHESP, Irset (Institut de recherche en santéenvironnement et travail) UMR_S 1085, CIC – P 1414RennesFrance
| | - Agnes Duveau
- Department of Nephrology and TransplantationUniversity of AngersAngersFrance
| | - Valerie Moal
- Aix Marseille UniversitéHôpitaux Universitaires de MarseilleHôpital ConceptionCentre de Néphrologie et Transplantation RénaleMarseilleFrance
| | - Gilles Blancho
- Department of Nephrology and TransplantationCenter Hospitalier Universitaire de NantesNantesFrance
| | - Philippe Grimbert
- AP‐HP, Nephrology and Renal Transplantation DepartmentInstitut Francilien de Recherche en Néphrologie et Transplantation (IFRNT)Groupe Hospitalier Henri‐Mondor/Albert‐ChenevierUniversité Paris‐Est‐Créteil, (UPEC)DHU (Département Hospitalo‐Universitaire) VIC (Virus‐Immunité‐Cancer)IMRB (Institut Mondor de Recherche Biomédicale)Equipe 21, INSERM U 955CréteilFrance
| | - Antoine Durrbach
- AP‐HP, Nephrology and Renal Transplantation DepartmentInstitut Francilien de Recherche en Néphrologie et Transplantation (IFRNT)Groupe Hospitalier Henri‐Mondor/Albert‐ChenevierUniversité Paris‐Est‐Créteil, (UPEC)DHU (Département Hospitalo‐Universitaire) VIC (Virus‐Immunité‐Cancer)IMRB (Institut Mondor de Recherche Biomédicale)Equipe 21, INSERM U 955CréteilFrance
| | - Bruno Moulin
- Department of Nephrology and TransplantationStrasbourg University HospitalINSERMUMR‐S 1109StrasbourgFrance
| | - Dany Anglicheau
- Department of Nephrology and TransplantationHôpital Universitaire NeckerAPHP CenterUniversité de Paris INEM INSERM U 1151CNRS UMR 8253ParisFrance
| | - Yvon Ruch
- Department of Infectious DiseasesStrasbourg University HospitalStrasbourgFrance
| | - Charlotte Kaeuffer
- Department of Infectious DiseasesStrasbourg University HospitalStrasbourgFrance
| | - Ilies Benotmane
- Department of Nephrology and TransplantationStrasbourg University HospitalINSERMUMR‐S 1109StrasbourgFrance
| | - Morgane Solis
- Department of VirologyStrasbourg University HospitalINSERMUMR‐S 1109StrasbourgFrance
| | - Yannick LeMeur
- Department of NephrologyCHU de BrestUMR1227Lymphocytes B et AutoimmunitéUniversité de BrestInsermLabex IGOBrestFrance
| | - Marc Hazzan
- Department of Nephrology and TransplantationUniversity of LilleLilleFrance
| | - Francois Danion
- Department of Infectious DiseasesStrasbourg University HospitalStrasbourgFrance
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24
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Esagian SM, Giannis D, Ziogas IA, Gianni P, Sala E, Döhner H. Challenges of Hematopoietic Stem Cell Transplantation in the Era of COVID-19. EXP CLIN TRANSPLANT 2021; 20:237-245. [PMID: 33641657 DOI: 10.6002/ect.2020.0326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic raised unprecedented concerns in the hematopoietic stem cell transplant community. The diagnosis of COVID-19 in these transplant recipients may require extensive laboratory testing and high clinical suspicion, as atypical clinical manifestations or other respiratory viral infections are common in this patient population. The underlying malignancies, immunosuppressed state, frequently observed coinfections, and advanced age in some patients may also predispose them to worse clinical outcomes. Similar outcomes have been previously described with other human coronaviruses, including the severe acute respiratory syndrome coronavirus and the Middle East respiratory syndrome coronavirus. Many hematopoietic stem cell transplant organizations have issued elaborative guidelines that aim to prevent transmission and hence adverse patient outcomes. All potential donors are thoroughly screened, and donated products are cryopreserved in advance. Potential hematopoietic stem cell transplant recipients are also screened, and most nonurgent transplant cases with low risk of progression and/or death are deferred. Current hematopoietic stem cell transplant recipients should adhere to precaution and isolation measures, while their transplant units should also follow strict safety protocols, similar to other infectious outbreaks. The prolonged susceptibility of hematopoietic stem cell transplant recipients to respiratory viral infections might necessitate extending these measures even after the peak of the outbreak until a gradually return to normality is possible.
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Affiliation(s)
- Stepan M Esagian
- From the Surgery Working Group, Society of Junior Doctors, Athens, Greece
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25
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Zhan GF, Wang Y, Yang N, Luo AL, Li SY. Digestive system involvement of infections with SARS-CoV-2 and other coronaviruses: Clinical manifestations and potential mechanisms. World J Gastroenterol 2021; 27:561-575. [PMID: 33642829 PMCID: PMC7901047 DOI: 10.3748/wjg.v27.i7.561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 12/28/2020] [Accepted: 01/13/2021] [Indexed: 02/06/2023] Open
Abstract
Although coronavirus (CoV) infection is often characterized by respiratory symptoms, the virus can also result in extrapulmonary symptoms, especially the symptoms related to the digestive system. The outbreak of coronavirus disease 2019 (COVID-19) is currently the world's most pressing public health threat and has a significant impact on civil societies and the global economy. The occurrence of digestive symptoms in patients with COVID-19 is closely related to the development and prognosis of the disease. Moreover, thus far, there are no specific antiviral drug or vaccine approved for the treatment or prevention of COVID-19. Therefore, we elaborate on the effects of CoVs on the digestive system and the potential underlying mechanisms.
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Affiliation(s)
- Gao-Feng Zhan
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Yue Wang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Ning Yang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Ai-Lin Luo
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Shi-Yong Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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26
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George J, Gracious N, Gopal A, Balan S, Murlidharan P, Gopalakrishnan S, Potty V, Kurup S. Low-dose induction immunosuppression in deceased donor kidney transplantation during coronavirus disease pandemic - A multicentric prospective observational study. INDIAN JOURNAL OF TRANSPLANTATION 2021. [DOI: 10.4103/ijot.ijot_111_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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27
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Lee J, Kim EJ, Ihn K, Lee JG, Joo DJ, Kim MS, Kim SI, Kim YS, Huh KH. The feasibility of organ transplantation during the COVID-19 outbreak: experiences from South Korea. KOREAN JOURNAL OF TRANSPLANTATION 2020; 34:257-264. [PMID: 35770112 PMCID: PMC9187045 DOI: 10.4285/kjt.20.0048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 12/19/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Juhan Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Jin Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kyong Ihn
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Geun Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Jin Joo
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Yu Seun Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu Ha Huh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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28
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Anirvan P, Bharali P, Gogoi M, Thuluvath PJ, Singh SP, Satapathy SK. Liver injury in COVID-19: The hepatic aspect of the respiratory syndrome - what we know so far. World J Hepatol 2020; 12:1182-1197. [PMID: 33442447 PMCID: PMC7772728 DOI: 10.4254/wjh.v12.i12.1182] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/21/2020] [Accepted: 11/17/2020] [Indexed: 02/06/2023] Open
Abstract
The 2019 novel coronavirus disease (COVID-19) pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has posed a serious threat to global public health. Although primarily, the infection causes lung injury, liver enzyme abnormalities have also been reported to occur during the course of the disease. We conducted an extensive literature review using the PubMed database on articles covering a broad range of issues related to COVID-19 and hepatic injury. The present review summarizes available information on the spectrum of liver involvement, the possible mechanisms and risk factors of liver injury due to SARS-CoV-2 infection, and the prognostic significance of the presence of liver injury. Hopefully, this review will enable clinicians, especially the hepatologists, to understand and manage the liver derangements they may encounter in these patients better and provide guidance for further studies on the liver injury of COVID-19.
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Affiliation(s)
- Prajna Anirvan
- Department of Gastroenterology, Sriram Chandra Bhanj Medical College, Cuttack 753007, Odisha, India
| | - Pankaj Bharali
- Department of Gastroenterology, Sriram Chandra Bhanj Medical College and Hospital, Cuttack 753007, Odisha, India
| | - Mrinal Gogoi
- Department of Gastroenterology, Sriram Chandra Bhanj Medical College and Hospital, Cuttack 753007, Odisha, India
| | - Paul J Thuluvath
- Department of Surgery and Medicine, Mercy Medical Center, Baltimore, MD 21202, United States
| | - Shivaram P Singh
- Department of Gastroenterology, Sriram Chandra Bhanj Medical College and Hospital, Cuttack 753007, Odisha, India
| | - Sanjaya K Satapathy
- Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases and Transplantation, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, NY 11030, United States.
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29
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Salvalaggio PR, Ferreira GF, Caliskan Y, Vest LS, Schnitzler MA, de Sandes-Freitas TV, Moura LR, Lam NN, Maldonado RA, Loupy A, Axelrod DA, Lentine KL. An International survey on living kidney donation and transplant practices during the COVID-19 pandemic. Transpl Infect Dis 2020; 23:e13526. [PMID: 33245844 PMCID: PMC7744917 DOI: 10.1111/tid.13526] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/14/2020] [Accepted: 11/08/2020] [Indexed: 12/23/2022]
Abstract
The scope of the impact of the Coronavirus disease 19 (COVID‐19) pandemic on living donor kidney transplantation (LDKT) practices across the world is not well‐defined. We received survey responses from 204 transplant centers internationally from May to June 2020 regarding the impact of the COVID‐19 pandemic on LDKT practices. Respondents represented 16 countries on five continents. Overall, 75% of responding centers reported that LDKT surgery was on hold (from 67% of North American centers to 91% of European centers). The majority (59%) of centers reported that new donor evaluations were stopped (from 46% of North American centers to 86% of European centers), with additional 23% of centers reporting important decrease in evaluations. Only 10% of centers reported slight variations on their evaluations. For the centers that continued donor evaluations, 40% performed in‐person visits, 68% by video, and 42% by telephone. Center concerns for donor (82%) and recipient (76%) safety were the leading barriers to LDKT during the pandemic, followed by patients concerns (48%), and government restrictions (46%). European centers reported more barriers related to staff limitations while North and Latin American centers were more concerned with testing capacity and insufficient resources including protective equipment. As LDKT resumes, 96% of the programs intend to screen donor and recipient pairs for coronavirus infection, most of them with polymerase chain reaction testing of nasopharyngeal swab samples. The COVID‐19 pandemic has had broad impact on all aspects of LDKT practice. Ongoing research and consensus‐building are needed to guide safe reopening of LDKT programs.
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Affiliation(s)
| | - Gustavo F Ferreira
- Department of Medicine, Santa Casa de Juiz de Fora, Juiz de Fora, Brazil
| | - Yasar Caliskan
- Saint Louis University Center for Abdominal Transplantation, Saint Louis University, St. Louis, MO, USA
| | - Luke S Vest
- Saint Louis University Center for Abdominal Transplantation, Saint Louis University, St. Louis, MO, USA
| | - Mark A Schnitzler
- Saint Louis University Center for Abdominal Transplantation, Saint Louis University, St. Louis, MO, USA
| | | | - Lucio R Moura
- Department of Medicine, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Ngan N Lam
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rafael A Maldonado
- Department of Medicine, Clinica Privada Vélez Sarsfield, Córdoba, Argentina
| | | | - David A Axelrod
- Department of Surgery, University of Iowa, Iowa City, IA, USA
| | - Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, Saint Louis University, St. Louis, MO, USA
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30
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Xu H, Zhou Y, Sun R, Liu X, Diao M, Ren X, Li L. A narrative review of the challenges and countermeasures in hepatoblastoma management during COVID-19 epidemic. Transl Pediatr 2020; 9:840-848. [PMID: 33457307 PMCID: PMC7804479 DOI: 10.21037/tp-20-143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/22/2020] [Indexed: 11/27/2022] Open
Abstract
An infectious disease named "coronavirus disease 2019" (COVID-19) currently has brought a threat to global health security and trends to be more and more severe in many countries. It also has introduced great challenges to the diagnosis and management of children with hepatoblastoma (HB). During the COVID-19 pandemic, pediatric surgeons should not only develop personalized treatment plans for HB therapy, but also emphasize the diagnosis, prevention, and treatment of this virus. Children with both HB and COVID-19 are recommended to undertake multidisciplinary assessment. Anti-SARS-CoV-2 therapy may be a preferred treatment for the infected without presenting a surgical emergency. However, emergent operation may be necessary for HB children with concurrent COVID-19 who developed a life-threatening surgical emergency condition. Otherwise, for children with negative virus examination results, treatment advice should be based on the impact of the epidemic and regional economic considerations. A "wait and see" strategy is recommended for children with resectable tumors after new adjuvant chemotherapy treatment (NACT). Assessment of liver transplantation is recommended for children with HB whose tumors cannot be resected after NACT. Children with HB with pulmonary metastasis may have abnormal findings on chest imaging due to COVID-19. Besides, the detailed therapeutic regimens may vary for children with HB with or without an emergency presentation. Based on previous consensus, current research, and the experiences of our hospital, we aim to offer available management plans for the above-mentioned concerns.
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Affiliation(s)
- Hang Xu
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Yan Zhou
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Rui Sun
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuelai Liu
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Mei Diao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xianghai Ren
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Long Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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31
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Lai Q, Spoletini G, Bianco G, Graceffa D, Agnes S, Rossi M, Lerut J. SARS-CoV2 and immunosuppression: A double-edged sword. Transpl Infect Dis 2020; 22:e13404. [PMID: 32639598 PMCID: PMC7361075 DOI: 10.1111/tid.13404] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 06/29/2020] [Indexed: 12/15/2022]
Abstract
Severe acute respiratory syndrome Coronavirus 2 (SARS-Cov2) outbreak has caused a pandemic rapidly impacting on the way of life of the entire world. This impact in the specific setting of transplantation and immunosuppression has been poorly explored to date. Discordant data exist on the impact of previous coronavirus outbreaks on immunosuppressed patients. Overall, only a very limited number of cases have been reported in literature, suggesting that transplanted patients not necessarily present an increased risk of severe SARS-Cov2-related disease compared to the general population. We conducted a literature review related to the impact of immunosuppression on coronavirus infections including case reports and series describing immunosuppression management in transplant recipients. The role of steroids, calcineurin inhibitors, and mycophenolic acid has been explored more in detail. A point-in-time snapshot of the yet released literature and some considerations in relation to the use of immunosuppression in SARS-Cov2 infected transplant recipients are provided here for the physicians dealing with immunocompromised patients.
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Affiliation(s)
- Quirino Lai
- Hepatobiliary and Organ Transplantation UnitSapienza University of RomeUmberto I Polyclinic of RomeRomeItaly
| | - Gabriele Spoletini
- General Surgery and Liver TransplantationFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Giuseppe Bianco
- General Surgery and Liver TransplantationFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Dario Graceffa
- Centre for the Study and Treatment of PsoriasisDepartment of Clinical DermatologySan Gallicano Dermatological InstituteIRCCSRomeItaly
| | - Salvatore Agnes
- General Surgery and Liver TransplantationFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Massimo Rossi
- General Surgery and Liver TransplantationFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Jan Lerut
- Institute for Experimental and Clinical Research *IREC ‐ Université catholique de Louvain – UCLBrusselsBelgium
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32
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Menon J, Shanmugam N, Patel K, Hakeem A, Reddy MS, Rela M. Awareness and concerns about novel coronavirus disease 2019 (COVID-19) among parents of pediatric liver transplant recipients. Pediatr Transplant 2020; 24:e13805. [PMID: 32663351 PMCID: PMC7404448 DOI: 10.1111/petr.13805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/06/2020] [Accepted: 07/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Pediatric transplant recipients may be at increased risk of developing serious infections due to COVID-19. We undertook a web-based survey among parents of post-liver transplant pediatric patients to assess knowledge and concerns regarding COVID-19 pandemic and impact of social media on them. METHODS This cross-sectional online survey was conducted between March 21 and March 26, 2020. A 19-item questionnaire was sent to 172 parents of post-liver transplant children. RESULTS 106 (62%) of parents responded. Median time since transplant was 31 (12-52) months. The majority of parents had good understanding regarding symptomatology and routes of transmission. Only 27% were aware of feco-oral transmission, and 34% knew about gastrointestinal symptoms of COVID-19. 100% of parents understood concept of social distancing, and 70% knew that asymptomatic individuals can transmit the virus. Television followed by newspapers was the main source of their information, though over 40% claim to regularly receive information through social media. 87% would consult their doctor if the child had flu-like symptoms rather than modify immunosuppression or try alternative medications. Parental concerns mainly revolved around early recognition of symptoms, queries on unconventional treatments circulating over social media, and supply of medications during the lockdown period. CONCLUSIONS The majority of parents had basic understanding of COVID-19 pandemic. Social media appeared to be an important source of information. Results from this survey helped us in modifying patient care protocols to ensure continuity of care while maintaining social distancing.
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Affiliation(s)
- Jagadeesh Menon
- Department of Pediatric gastroenterology & hepatologyDr Rela Institute and medical centerBharat Institute of Higher Education and researchIndia
| | - Naresh Shanmugam
- Department of Pediatric gastroenterology & hepatologyDr Rela Institute and medical centerBharat Institute of Higher Education and researchIndia
| | - Kinisha Patel
- Department of Pediatric gastroenterology & hepatologyDr Rela Institute and medical centerBharat Institute of Higher Education and researchIndia
| | - Abdul Hakeem
- Department of Hepatobiliary surgery and liver transplantationBharat Institute of Higher Education and research Dr Rela Institute and medical centerChennaiIndia
| | - Mettu Srinivas Reddy
- Department of Hepatobiliary surgery and liver transplantationBharat Institute of Higher Education and research Dr Rela Institute and medical centerChennaiIndia
| | - Mohamed Rela
- Department of Hepatobiliary surgery and liver transplantationBharat Institute of Higher Education and research Dr Rela Institute and medical centerChennaiIndia,Liver transplant unitKings college hospitalLondonUK
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Rabiee A, Sadowski B, Adeniji N, Perumalswami PV, Nguyen V, Moghe A, Latt NL, Kumar S, Aloman C, Catana AM, Bloom PP, Chavin KD, Carr RM, Dunn W, Chen VL, Aby ES, Debes JD, Dhanasekaran R. Liver Injury in Liver Transplant Recipients With Coronavirus Disease 2019 (COVID-19): U.S. Multicenter Experience. Hepatology 2020; 72:1900-1911. [PMID: 32964510 PMCID: PMC7537191 DOI: 10.1002/hep.31574] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/19/2020] [Accepted: 09/07/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Coronavirus disease 2019 (COVID-19) is associated with liver injury, but the prevalence and patterns of liver injury in liver transplantation (LT) recipients with COVID-19 are open for study. APPROACH AND RESULTS We conducted a multicenter study in the United States of 112 adult LT recipients with COVID-19. Median age was 61 years (interquartile range, 20), 54.5% (n = 61) were male, and 39.3% (n = 44) Hispanic. Mortality rate was 22.3% (n = 25); 72.3% (n = 81) were hospitalized and 26.8% (n = 30) admitted to the intensive care unit (ICU). Analysis of peak values of alanine aminotransferase (ALT) during COVID-19 showed moderate liver injury (ALT 2-5× upper limit of normal [ULN]) in 22.2% (n = 18) and severe liver injury (ALT > 5× ULN) in 12.3% (n = 10). Compared to age- and sex-matched nontransplant patients with chronic liver disease and COVID-19 (n = 375), incidence of acute liver injury was lower in LT recipients (47.5% vs. 34.6%; P = 0.037). Variables associated with liver injury in LT recipients were younger age (P = 0.009; odds ratio [OR], 2.06; 95% confidence interval [CI], 1.20-3.54), Hispanic ethnicity (P = 0.011; OR, 6.01; 95% CI, 1.51-23.9), metabolic syndrome (P = 0.016; OR, 5.87; 95% CI, 1.38-24.99), vasopressor use (P = 0.018; OR, 7.34; 95% CI, 1.39-38.52), and antibiotic use (P = 0.046; OR, 6.93; 95% CI, 1.04-46.26). Reduction in immunosuppression (49.4%) was not associated with liver injury (P = 0.156) or mortality (P = 0.084). Liver injury during COVID-19 was significantly associated with mortality (P = 0.007; OR, 6.91; 95% CI, 1.68-28.48) and ICU admission (P = 0.007; OR, 7.93; 95% CI, 1.75-35.69) in LT recipients. CONCLUSIONS Liver injury is associated with higher mortality and ICU admission in LT recipients with COVID-19. Hence, monitoring liver enzymes closely can help in early identification of patients at risk for adverse outcomes. Reduction of immunosuppression during COVID-19 did not increase risk for mortality or graft failure.
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Affiliation(s)
- Atoosa Rabiee
- Division of GastroenterologyVA Medical CenterWashingtonDC
| | - Brett Sadowski
- Division of GastroenterologyGeorgetown UniversityWashingtonDC
| | - Nia Adeniji
- Division of GastroenterologyStanford UniversityStanfordCA
| | | | | | - Akshata Moghe
- Division of GastroenterologyUniversity of Pittsburgh Medical CenterPA
| | - Nyan L. Latt
- Division of GastroenterologyOchsner Medical CenterLA
| | - Sonal Kumar
- Division of GastroenterologyWeill Cornell MedicineNY
| | - Costica Aloman
- Division of GastroenterologyRush University Medical CenterIL
| | | | | | - Kenneth D. Chavin
- Division of Transplant and Hepatobiliary SurgeryUniversity Hospitals Cleveland Medical CenterOH
| | | | - Winston Dunn
- Division of GastroenterologyKansas University Medical CenterKS
| | | | - Elizabeth S. Aby
- Division of GastroenterologyUniversity of MinnesotaMN
- Division of GastroenterologyHennepin County Medical CenterMN
| | - Jose D. Debes
- Division of GastroenterologyUniversity of MinnesotaMN
- Division of GastroenterologyHennepin County Medical CenterMN
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Mahamid A, Fenig Y, Florman S. Coronavirus Disease 2019 Pandemic: Early Observations in Abdominal Organ Transplantation. EXP CLIN TRANSPLANT 2020; 20:795-799. [PMID: 33272164 DOI: 10.6002/ect.2020.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The recent COVID-19 outbreak has quickly become a worldwide pandemic emergency. The course of this pandemic is still unknown, with more than 6 million cases identified and over 370 000 deaths globally as of June 1, 2020. The uncertainty and anxiety during this period will have a detrimental effect on the global health system. The organ transplantation field has been negatively affected by the COVID-19 pandemic, especially in regions where the intensity of cases exceeds the available capacity of the health care resources. Recently, scattered data have been published in the English literature, mainly in case reports and letters to the editor, that describe the effect of COVID-19 on donors and recipients of abdominal solid organs. Our objective is to review and draw conclusions from these data.
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Affiliation(s)
- Ahmad Mahamid
- From the Mount Sinai Hospital, Recanati/Miller Transplantation Institute, New York, New York, USA
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Shiina S, Gani RA, Yokosuka O, Maruyama H, Nagamatsu H, Payawal DA, Dokmeci AK, Lesmana LA, Tanwandee T, Lau G, Sarin SK, Omata M. APASL practical recommendations for the management of hepatocellular carcinoma in the era of COVID-19. Hepatol Int 2020; 14:920-929. [PMID: 33174159 PMCID: PMC7655459 DOI: 10.1007/s12072-020-10103-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/22/2020] [Indexed: 01/08/2023]
Abstract
Background COVID-19 has been giving the devastating impact on the current medical care system. There are quite many guidelines on COVID-19, but only a few on the management of hepatocellular carcinoma (HCC) during COVID-19 pandemic. Aims We develop these recommendations to preserve adequate clinical practice for the management of HCC. Methods Experts of HCC in the Asia–Pacific region exchanged opinions via webinar, and these recommendations were formed. Results Close contact should be minimized to reduce possible exposure of both medical staff and patients to the novel coronavirus. To prevent transmission of the virus, meticulous hygiene measures are important. With the decrease in regular medical service, the medical staff may be mobilized to provide COVID-19-related patient care. However, diagnosis and treatment of HCC should not be delayed because of COVID-19 pandemic. The management of HCC should be the same as in non-pandemic circumstances. HCC is highly malignant, thus it is recommended not to delay curative treatment such as surgery and ablation. However, a kind of triage is necessary even among patients with HCC when resources are insufficient for all to be treated. Curative treatments should be periodized and cytoreductive or non-curative treatment such as vascular interventions and systemic therapy may be postponed until it can be performed safely with sufficient resources. For patients with confirmed or suspected to be infected with the novel coronavirus, diagnosis and treatment should be postponed until the virus is eliminated or they are confirmed as not being infected with it. Conclusions These are collection of measures implemented by front-line medical professionals. We would evolve these recommendations over time as more real-world data becomes available.
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Affiliation(s)
- Shuichiro Shiina
- Department of Gastroenterology, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Rino A Gani
- Department of Internal Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | | | - Hitoshi Maruyama
- Department of Gastroenterology, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiroaki Nagamatsu
- Department of Gastroenterology, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | | | - A Kadir Dokmeci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Laurentius A Lesmana
- Digestive Disease and GI Oncology Center, Medistra, Hospital, University of Indonesia, Jakarta, Indonesia
| | - Tawesak Tanwandee
- Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - George Lau
- Humanity and Health Clinical Trial Center, Humanity and Health Medical Group, Hong Kong SAR, China.,Liver Disease and Transplant Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Masao Omata
- Department of Gastroenterology, Yamanashi Prefectural Central Hospital, Kofu-city, Yamanashi, Japan.,The University of Tokyo, Tokyo, Japan
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36
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Boyarsky BJ, Werbel WA, Durand CM, Avery RK, Jackson KR, Kernodle AB, Snyder J, Hirose R, Massie IM, Garonzik-Wang JM, Segev DL, Massie AB. Early national and center-level changes to kidney transplantation in the United States during the COVID-19 epidemic. Am J Transplant 2020; 20:3131-3139. [PMID: 32594606 PMCID: PMC7361931 DOI: 10.1111/ajt.16167] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/01/2020] [Accepted: 06/18/2020] [Indexed: 01/25/2023]
Abstract
In March 2020, coronavirus disease 2019 (COVID-19) spread rapidly nationally, causing widespread emergent changes to the health system. Our goal was to understand the impact of the epidemic on kidney transplantation (KT), at both the national and center levels, accounting statistically for waitlist composition. Using Scientific Registry of Transplant Recipients data, we compared data on observed waitlist registrations, waitlist mortality, and living-donor and deceased-donor kidney transplants (LDKT/DDKT) March 15-April 30, 2020 to expected events calculated from preepidemic data January 2016-February 2020. There were few changes before March 15, at which point the number of new listings/DDKT/LDKT dropped to 18%/24%/87% below the expected value (all P < .001). Only 12 centers performed LDKT March 15-31; by April 30, 40 centers had resumed LDKT. The decline in new listings and DDKT was greater among states with higher per capita confirmed COVID-19 cases. The number of waitlist deaths was 2.2-fold higher than expected in the 5 states with highest COVID-19 burden (P < .001). DCD DDKT and regional/national imports declined nationwide but most steeply in states with the highest COVID-19 burden. The COVID-19 epidemic has resulted in substantial changes to KT; we must adapt and learn rapidly to continue to provide safe access to transplantation and limit the growing indirect toll of an already deadly disease.
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Affiliation(s)
- Brian J. Boyarsky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christine M. Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robin K. Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kyle R. Jackson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amber B. Kernodle
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jon Snyder
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota, USA
| | - Ryutaro Hirose
- Department of Surgery, University of California, San Francisco, California, USA
| | | | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota, USA
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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37
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Liver Transplantation Activity in the Eurotransplant Area Is Recovering Slowly During the COVID-19 Crisis. Transplant Direct 2020; 6:e611. [PMID: 33134487 PMCID: PMC7546836 DOI: 10.1097/txd.0000000000001064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/21/2020] [Accepted: 08/22/2020] [Indexed: 12/18/2022] Open
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38
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Hong HL, Kim SH, Choi DL, Kwon HH. A case of coronavirus disease 2019-infected liver transplant donor. Am J Transplant 2020; 20:2938-2941. [PMID: 32400013 PMCID: PMC7272801 DOI: 10.1111/ajt.15997] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 01/25/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a novel infectious disease that continues to spread on a global scale. There has been growing concern about donor-derived transmissions of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Herein, we present the case of a patient who underwent ABO-incompatible living donor liver transplantation without knowing that the liver donor was infected with COVID-19 during the donation procedure. In this case, the donor-derived transmission to the recipient was not identified, and the liver donor was found to be recovering from a COVID-19 infection. The donor-derived transmission was not identified.
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Affiliation(s)
- Hyo-Lim Hong
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Lak Choi
- Surgery and Abdominal Organ Transplantation, Department of Surgery, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Hyun Hee Kwon
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea,Correspondence Hyun H. Kwon
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Becchetti C, Zambelli MF, Pasulo L, Donato MF, Invernizzi F, Detry O, Dahlqvist G, Ciccarelli O, Morelli MC, Fraga M, Svegliati-Baroni G, van Vlierberghe H, Coenraad MJ, Romero MC, de Gottardi A, Toniutto P, Del Prete L, Abbati C, Samuel D, Pirenne J, Nevens F, Dufour JF. COVID-19 in an international European liver transplant recipient cohort. Gut 2020; 69:1832-1840. [PMID: 32571972 PMCID: PMC7335697 DOI: 10.1136/gutjnl-2020-321923] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Knowledge on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in liver transplant recipients is lacking, particularly in terms of severity of the disease. The aim of this study was to describe the demographic, baseline clinical characteristics and early outcomes of a European cohort of liver transplant recipients with SARS-CoV-2 infection. DESIGN We conducted an international prospective study across Europe on liver transplant recipients with SARS-CoV-2 infection confirmed by microbiological assay during the first outbreak of COVID-19 pandemic. Baseline characteristics, clinical presentation, management of immunosuppressive therapy and outcomes were collected. RESULTS 57 patients were included (70% male, median (IQR) age at diagnosis 65 (57-70) years). 21 (37%), 32 (56%) and 21 (37%) patients had one cardiovascular disease, arterial hypertension and diabetes mellitus, respectively. The most common symptoms were fever (79%), cough (55%), dyspnoea (46%), fatigue or myalgia (56%) and GI symptoms (33%). Immunosuppression was reduced in 22 recipients (37%) and discontinued in 4 (7%). With this regard, no impact on outcome was observed. Forty-one (72%) subjects were hospitalised and 11 (19%) developed acute respiratory distress syndrome. Overall, we estimated a case fatality rate of 12% (95% CI 5% to 24%), which increased to 17% (95% CI 7% to 32%) among hospitalised patients. Five out of the seven patients who died had a history of cancer. CONCLUSION In this European multicentre prospective study of liver transplant recipients, COVID-19 was associated with an overall and in-hospital fatality rate of 12% (95% CI 5% to 24%) and 17% (95% CI 7% to 32%), respectively. A history of cancer was more frequent in patients with poorer outcome.
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Affiliation(s)
- Chiara Becchetti
- University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Marco Fabrizio Zambelli
- Department of Surgery, General Surgery and Abdominal Transplant Unit, "Papa Giovanni XXIII" Hospital, Bergamo, Bergamo, Lombardia, Italy
| | - Luisa Pasulo
- Gastroenterology and Transplant Hepatology, "Papa Giovanni XXIII" Hospital, Bergamo, Bergamo, Lombardia, Italy
| | - Maria Francesca Donato
- Transplant Hepatology Unit, Division of Gastroenterology and Hepatology, IRCSS Foundation Ca' Granda, Maggiore Hospital Policlinico, CRC "A.M. and A. Migliavacca" Center of Liver Disease, Milan, Italy
| | - Federica Invernizzi
- Transplant Hepatology Unit, Division of Gastroenterology and Hepatology, IRCSS Foundation Ca' Granda, Maggiore Hospital Policlinico, CRC "A.M. and A. Migliavacca" Center of Liver Disease, Milan, Italy
| | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, Central University Hospital of Liege, Liege, Belgium
| | - Géraldine Dahlqvist
- Hepatogastroenterology Unit, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Olga Ciccarelli
- Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Maria Cristina Morelli
- Department of Organ Failures and Transplantation, Universita degli Studi di Bologna Azienda Ospedaliera di Bologna Policlinico Sant'Orsola-Malpighi, Bologna, Emilia-Romagna, Italy
| | - Montserrat Fraga
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Gianluca Svegliati-Baroni
- Liver Injury and Transplant Unit, AOU Ospedali Riuniti di Ancona, Ancona, Marche, Italy
- Department of Clinical and Molecular Sciences and Obesity Center, Polytechnic University of Marche, Ancona, Marche, Italy
| | | | - Minneke J Coenraad
- Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Andrea de Gottardi
- Gastroenterology and Hepatology, Ente Ospedaliero Cantonale, Università della Svizzera Italiana, Lugano, Switzerland
| | - Pierluigi Toniutto
- Hepatology and Liver Transplant Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Friuli-Venezia Giulia, Italy
| | - Luca Del Prete
- Department of Surgery, General Surgery and Abdominal Transplant Unit, "Papa Giovanni XXIII" Hospital, Bergamo, Bergamo, Lombardia, Italy
| | - Claudia Abbati
- Department of Surgery, General Surgery and Abdominal Transplant Unit, "Papa Giovanni XXIII" Hospital, Bergamo, Bergamo, Lombardia, Italy
| | - Didier Samuel
- Centre Hépato-Biliaire, Paris-Saclay University, Inserm research unit, Hôpital Paul Brousse, Villejuif, France
| | - Jacques Pirenne
- Abdominal Transplant Surgery, KU Leuven Hospital, Leuven, Flanders, Belgium
| | | | - Jean-François Dufour
- University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
- Hepatology, Depertment of Biomedical Research, University of Bern, Bern, Switzerland
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Modi AR, Koval CE, Taege AJ, Modaresi Esfeh J, Eghtesad B, Narayanan Menon KV, Quintini C, Miller C. Coronavirus disease 2019 in an orthotopic liver transplant recipient living with human immunodeficiency virus. Transpl Infect Dis 2020; 22:e13351. [PMID: 32500666 PMCID: PMC7300493 DOI: 10.1111/tid.13351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/18/2020] [Accepted: 05/24/2020] [Indexed: 12/19/2022]
Abstract
Coronavirus disease 2019 (COVID-19), mediated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can manifest with flu-like illness and severe pneumonia with acute respiratory distress syndrome (ARDS). Immunocompromised patients merit particular attention as altered host immunity may influence both disease severity and duration of viral shedding as is described with several other ribonucleic acid respiratory viruses. Yet immunocompromised status alone, in the absence of other comorbidities, may not necessarily predict severe illness presentations and poorer clinical outcomes as indicated by recent reports of COVID-19-infected solid organ transplant recipients and people living with human immunodeficiency virus (HIV). Such patients may even be spared the robust inflammatory response that precipitates ARDS associated with COVID-19, complicating the management of iatrogenic immunosuppression in this setting. We present a case of an orthotopic liver transplant recipient with well-controlled HIV who successfully recovered from a mild, flu-like illness attributed to SARS-CoV-2.
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Affiliation(s)
- Anita R. Modi
- Department of Infectious Disease, Respiratory InstituteCleveland Clinic FoundationClevelandOHUSA
| | - Christine E. Koval
- Department of Infectious Disease, Respiratory InstituteCleveland Clinic FoundationClevelandOHUSA
| | - Alan J. Taege
- Department of Infectious Disease, Respiratory InstituteCleveland Clinic FoundationClevelandOHUSA
| | - Jamak Modaresi Esfeh
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery InstituteCleveland Clinic FoundationClevelandOHUSA
| | - Bijan Eghtesad
- Department of General Surgery, Digestive Disease and Surgery InstituteCleveland Clinic FoundationClevelandOHUSA
| | - K. V. Narayanan Menon
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery InstituteCleveland Clinic FoundationClevelandOHUSA
| | - Cristiano Quintini
- Department of General Surgery, Digestive Disease and Surgery InstituteCleveland Clinic FoundationClevelandOHUSA
| | - Charles Miller
- Department of General Surgery, Digestive Disease and Surgery InstituteCleveland Clinic FoundationClevelandOHUSA
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Fishman JA, Roberts MB, Zhang EW, Kumar D, Hirsch HH, Maggiore U. Case 29-2020: A 66-Year-Old Man with Fever and Shortness of Breath after Liver Transplantation. N Engl J Med 2020; 383:1168-1180. [PMID: 32937051 PMCID: PMC7510944 DOI: 10.1056/nejmcpc2004982] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Jay A Fishman
- From the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Massachusetts General Hospital, and the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Harvard Medical School - both in Boston; the Division of Infectious Diseases and Transplant Center, University Health Network and University of Toronto, Toronto (D.K.); the Transplantation and Clinical Virology Unit, Department of Biomedicine, University Hospital Basel, Basel, Switzerland (H.H.H.); and the Nephrology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy (U.M.)
| | - Matthew B Roberts
- From the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Massachusetts General Hospital, and the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Harvard Medical School - both in Boston; the Division of Infectious Diseases and Transplant Center, University Health Network and University of Toronto, Toronto (D.K.); the Transplantation and Clinical Virology Unit, Department of Biomedicine, University Hospital Basel, Basel, Switzerland (H.H.H.); and the Nephrology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy (U.M.)
| | - Eric W Zhang
- From the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Massachusetts General Hospital, and the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Harvard Medical School - both in Boston; the Division of Infectious Diseases and Transplant Center, University Health Network and University of Toronto, Toronto (D.K.); the Transplantation and Clinical Virology Unit, Department of Biomedicine, University Hospital Basel, Basel, Switzerland (H.H.H.); and the Nephrology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy (U.M.)
| | - Deepali Kumar
- From the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Massachusetts General Hospital, and the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Harvard Medical School - both in Boston; the Division of Infectious Diseases and Transplant Center, University Health Network and University of Toronto, Toronto (D.K.); the Transplantation and Clinical Virology Unit, Department of Biomedicine, University Hospital Basel, Basel, Switzerland (H.H.H.); and the Nephrology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy (U.M.)
| | - Hans H Hirsch
- From the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Massachusetts General Hospital, and the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Harvard Medical School - both in Boston; the Division of Infectious Diseases and Transplant Center, University Health Network and University of Toronto, Toronto (D.K.); the Transplantation and Clinical Virology Unit, Department of Biomedicine, University Hospital Basel, Basel, Switzerland (H.H.H.); and the Nephrology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy (U.M.)
| | - Umberto Maggiore
- From the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Massachusetts General Hospital, and the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Harvard Medical School - both in Boston; the Division of Infectious Diseases and Transplant Center, University Health Network and University of Toronto, Toronto (D.K.); the Transplantation and Clinical Virology Unit, Department of Biomedicine, University Hospital Basel, Basel, Switzerland (H.H.H.); and the Nephrology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy (U.M.)
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Domínguez-Gil B, Coll E, Fernández-Ruiz M, Corral E, del Río F, Zaragoza R, Rubio JJ, Hernández D. COVID-19 in Spain: Transplantation in the midst of the pandemic. Am J Transplant 2020; 20:2593-2598. [PMID: 32359194 PMCID: PMC7267131 DOI: 10.1111/ajt.15983] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 02/06/2023]
Abstract
Spain has been one of the most affected countries by the COVID-19 outbreak. As of April 28, 2020, the number of confirmed cases is 210 773, including 102 548 patients recovered, more than 10 300 admitted to the ICU, and 23 822 deaths, with a global case fatality rate of 11.3%. From the perspective of donation and transplantation, the Spanish system first focused on safety issues, providing recommendations for donor evaluation and testing, and to rule out SARS-CoV-2 infection in potential recipients prior to transplantation. Since the country entered into an epidemiological scenario of sustained community transmission and saturation of intensive care, developing donation and transplantation procedures has become highly complex. Since the national state of alarm was declared in Spain on March 13, 2020, the mean number of donors has declined from 7.2 to 1.2 per day, and the mean number of transplants from 16.1 to 2.1 per day. Increased mortality on the waiting list may become a collateral damage of this terrible pandemic.
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Affiliation(s)
| | | | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Chair of the Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Spain
| | - Esther Corral
- Transplant Coordination of the Autonomous Region of the Basque Country, Vitoria, Spain
| | - Francisco del Río
- Transplant Coordination of the Autonomous Region of Madrid, Madrid, Spain
| | - Rafael Zaragoza
- Transplant Coordination of the Autonomous Region of Valencia, Valencia, Spain
| | - Juan J. Rubio
- Intensive Care Unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Chair of the Transplant Group of the Spanish Society of Intensive and Critical Care and Coronary Units (SEMICYUC), Spain
| | - Domingo Hernández
- Nephrology Service, Hospital Regional Universitario de Málaga, Málaga, Spain
- IBIMA, RD16/0009/0006, Málaga, Spain
- President of the Spanish Society of Transplantation (SET), Spain
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43
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Rasekhi A, Hoseinyazdi M, Esmaeilian S, Teimouri A, Safaei A, Rafiee F. COVID-19 pneumonia presenting as a single pulmonary nodule in a kidney transplant recipient: A case report and literature review. Radiol Case Rep 2020; 15:1587-1590. [PMID: 32685075 PMCID: PMC7355959 DOI: 10.1016/j.radcr.2020.06.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/27/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Alireza Rasekhi
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Meisam Hoseinyazdi
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeid Esmaeilian
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Teimouri
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Akbar Safaei
- Research and Development Department, Fara Parto Medical Imaging and Interventional Radiology Center, Faqihi st, Shiraz, Iran
| | - Faranak Rafiee
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
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44
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Jaffe A, Schilsky ML, Deshpande R, Batra R. Liver Transplantation in the Time of COVID19: Barriers and Ethical Considerations for Management and Next Steps. Hepatol Commun 2020; 4:1242-1256. [PMID: 32838103 PMCID: PMC7361607 DOI: 10.1002/hep4.1568] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/04/2020] [Accepted: 06/19/2020] [Indexed: 12/15/2022] Open
Abstract
The recent outbreak of the novel virus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which causes the corona virus disease of 2019 (COVID19), has spread globally and affects millions of people. This pandemic has taxed our health care system and disrupted normal operations, even life-saving procedures, such as liver transplants. During these unprecedented times, providers and patients are imperiled and resources for diagnosis and care may be limited. Continuing to perform resource-intense advanced procedures is challenging, as is caring for patients with end-stage liver disease or patients with urgent needs for liver tumor control. Liver transplantation, in particular, requires critical resources, like blood products and critical care beds, which are fairly limited in the COVID19 pandemic. The potential of COVID19 infections in posttransplant recipients on immunosuppression and staff contacts further adds to the complexity. Therefore, transplant programs must reevaluate the ethicality, feasibility, and safety of performing liver transplants during this pandemic. Herein, we discuss the clinical and ethical challenges posed by performing liver transplants and offer guidance for managing patients with end-stage liver disease during the COVID19 pandemic.
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Affiliation(s)
- Ariel Jaffe
- Division of Digestive Diseases, Department of MedicineYale School of MedicineNew HavenCT
| | - Michael L. Schilsky
- Division of Digestive Diseases, Department of MedicineYale School of MedicineNew HavenCT
- Yale New Haven Transplantation CenterYale School of MedicineNew HavenCT
| | | | - Ramesh Batra
- Division of Digestive Diseases, Department of MedicineYale School of MedicineNew HavenCT
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45
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Chan SL, Kudo M. Impacts of COVID-19 on Liver Cancers: During and after the Pandemic. Liver Cancer 2020; 9:491-502. [PMID: 33078127 PMCID: PMC7490489 DOI: 10.1159/000510765] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/10/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The pandemic of coronavirus disease 2019 (COVID-19) has diverted resources from healthcare services for patients with chronic medical illness such as cancer. COVID-19 also causes organ dysfunction, complicating cancer treatment. In most countries with an outbreak of COVID-19, modifications of cancer management have been adopted to accommodate the crisis and minimize the exposure of cancer patients to the infection. In countries where COVID-19 numbers are subsiding, medical teams should also be prepared to resume normal practices gradually. Here, we aim to review the literature on the impact of COVID-19 on patients with hepatocellular carcinoma (HCC) as well as discuss modifications to the management of HCC during and after recovery from the pandemic. SUMMARY Based on current data, 10-40% of patients with COVID-19 have hepatic injury characterized by an elevation of transaminases and/or hyperbilirubinemia. Multiple mechanisms contribute to the hepatic injury, including direct viral entry to hepatocytes/cholangiocytes, immune-mediated hepatitis, hypoxia, and drug-related hepatotoxicity. In patients with HCC, COVID-19 may exacerbate existing chronic liver disease and complicate the management of cancer. Cancer patients generally have a higher risk of infection and worse outcome, especially those who have recently undergone cancer treatment. Although HCC is under-represented in COVID-19 series, mitigation measures should be implemented to minimize the exposure of patients to the virus. A decision on the treatment of HCC should be balanced with consideration of the availability of medical resources, the level of infection risk of COVID-19, and the risk-benefit ratio of the individual patient. In areas where the COVID-19 outbreak is subsiding, clinicians should be prepared to manage a surge of HCC patients with higher disease burdens and complications. KEY MESSAGES Mitigation measures to protect at-risk patients, such as those with cancers, from SARS-CoV-2 infection should be exercised and the impact of COVID-19 on this group of patients should be thoroughly studied.
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Affiliation(s)
- Stephen Lam Chan
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, Sir YK Pao Centre for Cancer, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Hand in Hand Cancer Foundation, Hong Kong, Hong Kong
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osakasayama, Japan
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46
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Moosavi SA, Mashhadiagha A, Motazedian N, Hashemazar A, Hoveidaei AH, Bolignano D. COVID-19 clinical manifestations and treatment strategies among solid-organ recipients: A systematic review of cases. Transpl Infect Dis 2020; 22:e13427. [PMID: 32779820 PMCID: PMC7404594 DOI: 10.1111/tid.13427] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND COVID-19 has been spreading worldwide with a significant death toll. Solid-organ transplantation (SOT) recipients are at higher risk due to their suppressed immune system. In this study, we aimed to conduct a systematic review on COVID-19 clinical manifestations and treatment strategies in SOT recipients. METHODS We searched three databases for relevant terms related to COVID-19 and transplantation. 50 studies, including 337 patients, were reviewed. RESULTS Two hundred thirty six patients were male, with a mean age of 49.9 years. The most prevalent group was the kidney 57.0%, followed by 17.2% heart and 13.6% liver. Fever and cough were the most reported clinical presentations. Infiltration (55.4%) in chest x-ray and ground-glass opacity (67.1%) in CT scans were the most radiological findings. It was found that 96.8% and 72.4% of patients present with CRP level and lymphocytopenia, respectively, and 70.6% of kidney recipients patients presented with high creatinine levels. The most common baseline immunosuppressants were calcineurin inhibitors (88.9%) and antimetabolites (73.2%). Antimetabolites (84.3%) and calcineurin inhibitors (54.3%) were discontinued/decreased 84.3% whereas glucocorticoids dosage almost has no change (77.9%) or even increased. 18.4% of cases had died, and 65.9% were discharged. CONCLUSIONS Patients' demographics, signs, symptoms, and radiographic findings in SOT recipients are almost similar to the general population. However, gastrointestinal symptoms appear to be more common. There are different treatment strategies, but in most of them, antimetabolite and calcineurin inhibitors were decreased or discontinued, while corticosteroids were increased. Finally, COVID-19 seems to be more severe and has higher mortality in SOT recipients compared to the general population.
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Affiliation(s)
- Seyed Ali Moosavi
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirali Mashhadiagha
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Motazedian
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Hashemazar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Human Hoveidaei
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Davide Bolignano
- Department of Surgical and Medical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
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47
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Spoletini G, Bianco G, Graceffa D, Lai Q. Transplantation during the COVID-19 pandemic: nothing noble is accomplished without danger. BMC Gastroenterol 2020; 20:259. [PMID: 32762651 PMCID: PMC7407436 DOI: 10.1186/s12876-020-01401-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023] Open
Abstract
The global health crisis due to the fast spread of coronavirus disease (COVID-19) has caused major disruption in all aspects of healthcare. Transplantation is one of the most affected sectors, as it relies on a variety of services that have been drastically occupied to treat patients affected by COVID-19. With this report from two transplant centers in Italy, we aim to reflect on resource organization, organ allocation, virus testing and transplant service provision during the course of the pandemic and to provide actionable information highlighting advantages and drawbacks.To what extent can we preserve the noble purpose of transplantation in times of increased danger? Strategies to minimize risk exposure to the transplant population and health- workers include systematic virus screening, protection devices, social distancing and reduction of patients visits to the transplant center. While resources for the transplant activity are inevitably reduced, new dilemmas arise to the transplant community: further optimization of time constraints during organ retrievals and implantation, less organs and blood products donated, limited space in the intensive care unit and the duty to maintain safety and outcomes.
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Affiliation(s)
- Gabriele Spoletini
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Giuseppe Bianco
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Dario Graceffa
- Centre for the Study and Treatment of Psoriasis, Department of Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Quirino Lai
- Hepatobiliary and Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy
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48
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Domínguez-Gil B, Coll E, Ferrer-Fàbrega J, Briceño J, Ríos A. Dramatic Impact of the COVID-19 Outbreak on Donation and Transplantation Activities in Spain. CIRUGÍA ESPAÑOLA (ENGLISH EDITION) 2020. [PMCID: PMC7368909 DOI: 10.1016/j.cireng.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Joana Ferrer-Fàbrega
- Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic, Barcelona, Spain
- Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clínic Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Javier Briceño
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático y pancreático, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Antonio Ríos
- Unidad de Trasplantes, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB, Universidad de Murcia, Murcia, Spain
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49
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Domínguez-Gil B, Coll E, Ferrer-Fàbrega J, Briceño J, Ríos A. Dramatic impact of the COVID-19 outbreak on donation and transplantation activities in Spain. Cir Esp 2020; 98:412-414. [PMID: 32362364 PMCID: PMC7368909 DOI: 10.1016/j.ciresp.2020.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Joana Ferrer-Fàbrega
- Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic, Barcelona, España; Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clínic, Barcelona, España; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Universidad de Barcelona, Barcelona, España
| | - Javier Briceño
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, España
| | - Antonio Ríos
- Unidad de Trasplantes, Hospital Clínico Universitario Virgen de la Arrixaca-IMIB, Universidad de Murcia, Murcia, España
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50
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Bösch F, Börner N, Kemmner S, Lampert C, Jacob S, Koliogiannis D, Stangl M, Michel S, Kneidinger N, Schneider C, Fischereder M, Irlbeck M, Denk G, Werner J, Angele MK, Guba MO. Attenuated early inflammatory response in solid organ recipients with COVID-19. Clin Transplant 2020; 34:e14027. [PMID: 32589760 PMCID: PMC7361260 DOI: 10.1111/ctr.14027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022]
Abstract
Immunosuppression leaves transplanted patients at particular risk for severe acute respiratory syndrome 2 (SARS‐CoV‐2) infection. The specific features of coronavirus disease 2019 (COVID‐19) in immunosuppressed patients are largely unknown and therapeutic experience is lacking. Seven transplanted patients (two liver, three kidneys, one double lung, one heart) admitted to the Ludwig‐Maximilians‐University Munich because of COVID‐19 and tested positive for SARS‐CoV‐2 were included. The clinical course and the clinical findings were extracted from the medical record. The two liver transplant patients and the heart transplant patient had an uncomplicated course and were discharged after 14, 18, and 12 days, respectively. Two kidney transplant recipients were intubated within 48 hours. One kidney and the lung transplant recipients were required to intubate after 10 and 15 days, respectively. Immunosuppression was adapted in five patients, but continued in all patients. Compared to non‐transplanted patients at the ICU (n = 19) the inflammatory response was attenuated in transplanted patients, which was proven by decreased IL‐6 blood values. This analysis might provide evidence that continuous immunosuppression is safe and probably beneficial since there was no hyperinflammation evident. Although transplanted patients might be more susceptible to an infection with SARS‐CoV‐2, their clinical course seems to be similar to immunocompetent patients.
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Affiliation(s)
- Florian Bösch
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.,Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Nikolaus Börner
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.,Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stephan Kemmner
- Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christopher Lampert
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sven Jacob
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Dionysios Koliogiannis
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.,Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Manfred Stangl
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.,Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sebastian Michel
- Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Clinic of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - Nikolaus Kneidinger
- Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
| | - Christian Schneider
- Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Center for Thoracic Surgery Munich, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Fischereder
- Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Renal Division, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Irlbeck
- Department of Anesthesiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Gerald Denk
- Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.,Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Martin K Angele
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.,Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Markus O Guba
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.,Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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