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Lauterio A, Cillo U, Spada M, Trapani S, De Carlis R, Bottino G, Bernasconi D, Scalamogna C, Pinelli D, Cintorino D, D'Amico FE, Spagnoletti G, Miggino M, Romagnoli R, Centonze L, Caccamo L, Baccarani U, Carraro A, Cescon M, Vivarelli M, Mazaferro V, Ettorre GM, Rossi M, Vennarecci G, De Simone P, Angelico R, Agnes S, Di Benedetto F, Lupo LG, Zamboni F, Zefelippo A, Patrono D, Diviacco P, Laureiro ZL, Gringeri E, Di Francesco F, Lucianetti A, Valsecchi MG, Gruttadauria S, De Feo T, Cardillo M, De Carlis L, Colledan M, Andorno E. Improving outcomes of in situ split liver transplantation in Italy over the last 25 years. J Hepatol 2023; 79:1459-1468. [PMID: 37516203 DOI: 10.1016/j.jhep.2023.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND & AIMS Split liver transplant(ation) (SLT) is still considered a challenging procedure that is by no means widely accepted. We aimed to present data on 25-year trends in SLT in Italy, and to investigate if, and to what extent, outcomes have improved nationwide during this time. METHODS The study included all consecutive SLTs performed from May 1993 to December 2019, divided into three consecutive periods: 1993-2005, 2006-2014, and 2015-2019, which match changes in national allocation policies. Primary outcomes were patient and graft survival, and the relative impact of each study period. RESULTS SLT accounted for 8.9% of all liver transplants performed in Italy. A total of 1,715 in situ split liver grafts were included in the analysis: 868 left lateral segments (LLSs) and 847 extended right grafts (ERGs). A significant improvement in patient and graft survival (p <0.001) was observed with ERGs over the three periods. Predictors of graft survival were cold ischaemia time (CIT) <6 h (p = 0.009), UNOS status 2b (p <0.001), UNOS status 3 (p = 0.009), and transplant centre volumes: 25-50 cases vs. <25 cases (p = 0.003). Patient survival was significantly higher with LLS grafts in period 2 vs. period 1 (p = 0.008). No significant improvement in graft survival was seen over the three periods, where predictors of graft survival were CIT <6 h (p = 0.007), CIT <6 h vs. ≥10 h (p = 0.019), UNOS status 2b (p = 0.038), and UNOS status 3 (p = 0.009). Retransplantation was a risk factor in split liver graft recipients, with significantly worse graft and patient survival for both types of graft (p <0.001). CONCLUSIONS Our analysis showed Italian SLT outcomes to have improved over the last 25 years. These results could help to dispel reservations regarding the use of this procedure. IMPACT AND IMPLICATIONS Split liver transplant(ation) (SLT) is still considered a challenging procedure and is by no means widely accepted. This study included all consecutive in situ SLTs performed in Italy from May 1993 to December 2019. With more than 1,700 cases, it is one of the largest series, examining long-term national trends in in situ SLT since its introduction. The data presented indicate that the outcomes of SLT improved during this 25-year period. Improvements are probably due to better recipient selection, refinements in surgical technique, conservative graft-to-recipient matching, and the continuous, yet carefully managed, expansion of donor selection criteria under a strict mandatory split liver allocation policy. These results could help to dispel reservations regarding the use of this procedure.
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Affiliation(s)
- Andrea Lauterio
- Department of Transplantation, Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplant Unit, Padua University Hospital, Padova, Italy
| | - Marco Spada
- Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, European Reference Network "TransplantChild", Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - Silvia Trapani
- Italian National Transplant Center-Istituto Superiore Di Sanità, Rome, Italy
| | - Riccardo De Carlis
- Department of Transplantation, Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; PhD Course in Clinical and Experimental Sciences, University of Padua, Padua, Italy
| | - Giuliano Bottino
- Department of Hepatobiliarypancreatic Surgery and Liver Transplantation Unit, A.O.U. S. Martino, Genova, Italy
| | - Davide Bernasconi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Chiara Scalamogna
- North Italy Transplant Program (NITp), UOC Coordinamento Trapianti, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Domenico Pinelli
- Department of Organ Failure and Transplantation, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Davide Cintorino
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy
| | | | - Gionata Spagnoletti
- Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, European Reference Network "TransplantChild", Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - Marco Miggino
- Department of Hepatobiliarypancreatic Surgery and Liver Transplantation Unit, A.O.U. S. Martino, Genova, Italy
| | - Renato Romagnoli
- Liver Transplant Center, General Surgery 2U, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Leonardo Centonze
- Department of Transplantation, Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Lucio Caccamo
- Division of General Surgery and Liver Transplantation, Fondazione Cà Granda IRCCS, Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Umberto Baccarani
- Department of Medicine, Liver Transplant Center, University of Udine, Italy
| | - Amedeo Carraro
- Liver Transplant Unit, University and Hospital Trust of Verona, Italy
| | - Matteo Cescon
- Hepatobiliary Surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Vivarelli
- HPB Surgery and Transplantation Unit, United Hospital of Ancona, Department of Experimental and Clinical Medicine Polytechnic University of Marche, Ancona, Italy
| | - Vincenzo Mazaferro
- Department of Oncology and Onco-Hematology, University of Milan, Italy; Department of Surgery, Istituto Nazionale Tumori Fondazione IRCCS Milan, Italy
| | - Giuseppe Maria Ettorre
- Division of General Surgery and Liver Transplantation, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Massimo Rossi
- General Surgery and Organ Transplantation, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy
| | - Giovanni Vennarecci
- Division of Hepatobiliary Surgery and Liver Transplant Center, AORN Cardarelli, Naples, Italy
| | - Paolo De Simone
- Hepatobiliary Surgery and Liver Transplantation AOU Pisana, Pisa, Italy
| | - Roberta Angelico
- Department of Surgical Sciences, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Salvatore Agnes
- Department of Surgery, Transplantation Service, Catholic University of the Sacred Heart, Foundation A. Gemelli Hospital, Rome, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit Azienda Ospedaliera Policlinico, University of Modena and Reggio Emilia Modena, Italy
| | - Luigi Giovanni Lupo
- General Surgery and Liver Transplantation Unit, University of Bari, Bari, Italy
| | - Fausto Zamboni
- Department of Surgery, General and Hepatic Transplantation Surgery Unit, A.O.B. Brotzu, Cagliari, Italy
| | - Arianna Zefelippo
- Division of General Surgery and Liver Transplantation, Fondazione Cà Granda IRCCS, Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Damiano Patrono
- Liver Transplant Center, General Surgery 2U, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Pietro Diviacco
- Department of Hepatobiliarypancreatic Surgery and Liver Transplantation Unit, A.O.U. S. Martino, Genova, Italy
| | - Zoe Larghi Laureiro
- Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, European Reference Network "TransplantChild", Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - Enrico Gringeri
- Hepatobiliary Surgery and Liver Transplant Unit, Padua University Hospital, Padova, Italy
| | - Fabrizio Di Francesco
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy
| | - Alessandro Lucianetti
- First Department of General Surgery, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Maria Grazia Valsecchi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy; Department of Surgery and Medical and Surgical Specialties, University of Catania, 95124, Catania, Italy
| | - Tullia De Feo
- North Italy Transplant Program (NITp), UOC Coordinamento Trapianti, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Cardillo
- Italian National Transplant Center-Istituto Superiore Di Sanità, Rome, Italy
| | - Luciano De Carlis
- Department of Transplantation, Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Michele Colledan
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Organ Failure and Transplantation, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Enzo Andorno
- Department of Hepatobiliarypancreatic Surgery and Liver Transplantation Unit, A.O.U. S. Martino, Genova, Italy
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Fortunato AC, Pinheiro RS, Fernandes MR, Nacif LS, Arantes RM, Rocha-Santos V, Waisberg DR, De Martino RB, Ducatti L, Haddad LB, Song AT, Abdala E, Andraus W, Carneiro-D'Albuquerque LA. COVID-19 Pandemic Impact on Liver Donation in the Largest Brazilian Transplantation Center. Transplant Proc 2022; 54:1212-1214. [PMID: 35811150 PMCID: PMC9021359 DOI: 10.1016/j.transproceed.2022.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND COVID-19 has spread worldwide and has become a public health emergency and a pandemic of international concern. The solid organ donation system was no different. This study aimed to investigate the effect of COVID-19 on the liver transplant (LT) system in Brazilian territory. METHODS We retrospectively reviewed all liver donor records allocated in São Paulo State, Brazil, 1 year before and 1 year during the COVID-19 pandemic. We defined the pre-COVID-19 (PRE) period as between April 2019 and April 2020 and the post-COVID-19 (POST) period as between April 2020 and April 2021. Moreover, we compared LT performed in our institution during these periods. To evaluate outcomes, we compared 30-day survival after LT. RESULTS In the PRE period, 1452 livers were offered for donation in São Paulo State and other Brazilian territories. Of these, 592 were used in LT. In the POST period, 1314 livers were offered for donation, but only 477 were used in LT. Organ refusal was higher in the POST period (P < .05). Our center performed 127 and 156 LTs in these periods, respectively, and an increase above 20% was significant (P = .039). There was no difference in 30-day survival between the periods (87.2% vs 87.9%, P > .5, respectively). CONCLUSIONS The COVID-19 pandemic harmed potential and allocated donors and LTs performed. However, it is possible to maintain the LT volume of a transplant center without compromising survival outcomes through preventive strategies against COVID-19 propagation.
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Affiliation(s)
- Allana C Fortunato
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil.
| | - Rafael S Pinheiro
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Michel Ribeiro Fernandes
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Lucas Souto Nacif
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rubens Macedo Arantes
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Vinicius Rocha-Santos
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Daniel Reis Waisberg
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rodrigo Bronze De Martino
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Liliana Ducatti
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Luciana Bertocco Haddad
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Alice Tung Song
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Edson Abdala
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Wellington Andraus
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Luiz Augusto Carneiro-D'Albuquerque
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
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Weiss MJ, Hornby L, Foroutan F, Belga S, Bernier S, Bhat M, Buchan CA, Gagnon M, Hardman G, Ibrahim M, Luo C, Luong ML, Mainra R, Manara AR, Sapir-Pichhadze R, Shalhoub S, Shaver T, Singh JM, Srinathan S, Thomas I, Wilson LC, Wilson TM, Wright A, Mah A. Clinical Practice Guideline for Solid Organ Donation and Transplantation During the COVID-19 Pandemic. Transplant Direct 2021; 7:e755. [PMID: 34514110 PMCID: PMC8425831 DOI: 10.1097/txd.0000000000001199] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 12/15/2022] Open
Abstract
The coronavirus 2019 (COVID-19) pandemic has disrupted health systems worldwide, including solid organ donation and transplantation programs. Guidance on how best to screen patients who are potential organ donors to minimize the risks of COVID-19 as well as how best to manage immunosuppression and reduce the risk of COVID-19 and manage infection in solid organ transplant recipients (SOTr) is needed. METHODS Iterative literature searches were conducted, the last being January 2021, by a team of 3 information specialists. Stakeholders representing key groups undertook the systematic reviews and generation of recommendations using a rapid response approach that respected the Appraisal of Guidelines for Research and Evaluation II and Grading of Recommendations, Assessment, Development and Evaluations frameworks. RESULTS The systematic reviews addressed multiple questions of interest. In this guidance document, we make 4 strong recommendations, 7 weak recommendations, 3 good practice statements, and 3 statements of "no recommendation." CONCLUSIONS SOTr and patients on the waitlist are populations of interest in the COVID-19 pandemic. Currently, there is a paucity of high-quality evidence to guide decisions around deceased donation assessments and the management of SOTr and waitlist patients. Inclusion of these populations in clinical trials of therapeutic interventions, including vaccine candidates, is essential to guide best practices.
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Affiliation(s)
- Matthew J Weiss
- Transplant Québec, Montréal, QC, Canada
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, QC, Canada
- Canadian Donation and Transplantation Research Program (CDTRP), Ottawa, ON, Canada
| | - Laura Hornby
- Canadian Donation and Transplantation Research Program (CDTRP), Ottawa, ON, Canada
- System Development - Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Farid Foroutan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, Toronto, ON, Canada
| | - Sara Belga
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Mamatha Bhat
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Multiorgan Transplant Program, University Health Network, University of Toronto, Toronto, ON, Canada
| | - C Arianne Buchan
- Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Michael Gagnon
- Division of Nephrology and Multi-Organ Transplant Program, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Gillian Hardman
- National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Maria Ibrahim
- National Health Service Blood and Transplant, Bristol, United Kingdom
- Kings College, London, United Kingdom
| | - Cindy Luo
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Me-Linh Luong
- Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montréal, QC, Canada
| | - Rahul Mainra
- Division of Nephrology, University of Saskatchewan, Saskatoon, SK, Canada
- St. Paul's Hospital, Saskatchewan Transplant Program, Saskatoon, SK, Canada
| | - Alex R Manara
- National Health Service Blood and Transplant, Bristol, United Kingdom
- Department of Intensive Care Medicine, Southmead Hospital, Bristol, United Kingdom
| | - Ruth Sapir-Pichhadze
- Division of Nephrology and Multi-Organ Transplant Program, Department of Medicine, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Sarah Shalhoub
- Division of Infectious Diseases, Department of Medicine, Western University, London, ON, Canada
| | - Tina Shaver
- Southern Alberta Organ and Tissue Donation Program, Calgary, AB, Canada
| | - Jeffrey M Singh
- Department of Medicine, University of Toronto, Toronto, Ontario, ON, Canada
- Trillium Gift of Life Network, Toronto, ON, Canada
| | - Sujitha Srinathan
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ian Thomas
- National Health Service Blood and Transplant, Bristol, United Kingdom
- Department of Intensive Care Medicine, Southmead Hospital, Bristol, United Kingdom
| | - Lindsay C Wilson
- System Development - Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - T Murray Wilson
- Transplant Research Foundation of British Columbia, Vancouver, BC, Canada
- Patient Partner, Canadian Donation and Transplantation Research Program
- The Alberta ORGANization Group, Edmonton, AB, Canada
| | - Alissa Wright
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Allison Mah
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Lauterio A, De Carlis R, Valsecchi M, Vella I, Zaniboni M, Fumagalli R, De Carlis L. Liver transplantation during the COVID-19 pandemic: A 2020 year-end report from Lombardy, northern Italy. Transpl Int 2021; 34:1984-1986. [PMID: 34148258 DOI: 10.1111/tri.13953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Lauterio
- Department of Transplantation. Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Riccardo De Carlis
- Department of Transplantation. Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mila Valsecchi
- Department of Anesthesiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Ivan Vella
- Department of Transplantation. Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Zaniboni
- Department of Anesthesiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Roberto Fumagalli
- Department of Anesthesiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Luciano De Carlis
- Department of Transplantation. Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- International Center for Digestive Health, University of Milano-Bicocca, Milan, Italy
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O'Rielly C, Ng-Kamstra J, Kania-Richmond A, Dort J, White J, Robert J, Brindle M, Sauro K. Surgery and COVID-19: a rapid scoping review of the impact of the first wave of COVID-19 on surgical services. BMJ Open 2021; 11:e043966. [PMID: 34130956 PMCID: PMC8210688 DOI: 10.1136/bmjopen-2020-043966] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 05/18/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To understand how surgical services have been reorganised during and following public health emergencies, particularly the first wave of the COVID-19 pandemic, and the consequences for patients, healthcare providers and healthcare systems. DESIGN A rapid scoping review. SETTING We searched the MEDLINE, Embase and grey literature sources for documents and press releases from governments and surgical organisations or associations. PARTICIPANTS Studies examining surgical service delivery during public health emergencies including COVID-19, and the impact on patients, providers and healthcare systems were included. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were strategies implemented for the reorganisation of surgical services. Secondary were the impacts of reorganisation and resuming surgical services, such as: adverse events (including morbidity and mortality), primary care and emergency department visits, length of hospital and ICU stay, and changes to surgical waitlists. RESULTS One hundred and thirty-two studies were included in this review; 111 described reorganisation of surgical services, 55 described the consequences of reorganising surgical services; and 6 reported actions taken to rebuild surgical capacity in public health emergencies. Reorganisations of surgical services were grouped under six domains: case selection/triage, personal protective equipment (PPE) regulations and practice, workforce composition and deployment, outpatient and inpatient patient care, resident and fellow education, and the hospital or clinical environment. Service reorganisations led to large reductions in non-urgent surgical volumes, increases in surgical wait times and impacted medical training (ie, reduced case involvement) and patient outcomes (eg, increases in pain). Strategies for rebuilding surgical capacity were scarce but focused on the availability of staff, PPE and patient readiness for surgery as key factors to consider before resuming services. CONCLUSIONS Reorganisation of surgical services in response to public health emergencies appears to be context dependent and has far-reaching consequences that must be better understood in order to optimise future health system responses to public health emergencies.
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Affiliation(s)
- Connor O'Rielly
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joshua Ng-Kamstra
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Joseph Dort
- University of Calgary, Calgary, Alberta, Canada
| | - Jonathan White
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jill Robert
- Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Mary Brindle
- Department of Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Khara Sauro
- Community Health Sciences, Surgery & Oncology, University of Calgary, Calgary, Alberta, Canada
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Chieregato A, Veronese G, Curto F, Zaniboni M, Fossi F, Zumbo F, Scattolini C, Compagnone C, Alberti BM, Baciu C, Bergesio L, Carenini SM, Cipolla C, Formentano AC, Guidi A, Massimo F, Galluccio I, Pagani S, Paparone R, Pozzi F, Pressato L, Pugnetti E, Riganti M, Ruggieri F, Tagliaferri F, Trinchero G, Vassena E, Bassi G, Giudici R, Sacchi M, Chiara O, Agostoni EC, Grasselli G, Fumagalli R. Emergently planned exclusive hub-and-spoke system in the epicenter of the first wave of COVID-19 pandemic in Italy: the experience of the largest COVID-19-free ICU hub for time-dependent diseases. Minerva Anestesiol 2021; 87:1091-1099. [PMID: 34102806 DOI: 10.23736/s0375-9393.21.15455-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lombardy was the epicenter in Italy of the first wave of COVID-19 pandemic. To face the contagion growth, from March 8 to May 8 2020, a regional law re-designed the hub-and-spoke system for time-dependent diseases to better allocate resources for COVID-19 patients. METHODS We report the reorganization of the major hospital in Lombardy during COVID-19 pandemic, including the rearrangement of its ICU beds to face COVID-19 pandemic and fulfill its role as extended hub for time-dependent diseases while preserving transplant activity. To highlight the impact of the emergently planned hub-and-spoke system, all patients admitted to a COVID-19-free ICU hub for trauma, neurosurgical emergencies and stroke during the two-month period were retrospectively collected and compared to 2019 cohort. Regional data on organ procurement was retrieved. Observed-to-expected (OE) in-ICU mortality ratios were computed to test the impact of the pandemic on patients affected by time-dependent diseases. RESULTS Dynamic changes in ICU resource allocation occurred according to local COVID-19 epidemiology/trends of patients referred for time-dependent diseases. The absolute increase of admissions for trauma, neurosurgical emergencies and stroke was roughly two-fold. Patients referred to the hub were older and characterized by more severe conditions. An increase in crude mortality was observed, though OE ratios for in-ICU mortality were not statistically different when comparing 2020 vs. 2019. An increase in local organ procurement was observed, limiting the debacle of regional transplant activity. CONCLUSIONS We described the effects of a regional emergently planned hub-and-spoke system for time-dependent diseases settled in the epicenter of COVID-19 pandemic in Italy.
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Affiliation(s)
- Arturo Chieregato
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy -
| | - Giacomo Veronese
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Francesco Curto
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Zaniboni
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesca Fossi
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabrizio Zumbo
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Carla Scattolini
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Christian Compagnone
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Beatrice M Alberti
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Camelia Baciu
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lavinia Bergesio
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano M Carenini
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Cristiana Cipolla
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Alessandro Guidi
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Massimo
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Irene Galluccio
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvano Pagani
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Rosaria Paparone
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federico Pozzi
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lorenzo Pressato
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Enrica Pugnetti
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mauro Riganti
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Ruggieri
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fernanda Tagliaferri
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gabriele Trinchero
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Emanuele Vassena
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gabriele Bassi
- Department of Anesthesia and Intensive Care 1, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Riccardo Giudici
- Department of Anesthesia and Intensive Care 1, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Sacchi
- SOREU, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Local Organ Procurement Organization, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Osvaldo Chiara
- School of Medicine and Surgery, University of Milan, Milan, Italy.,Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elio C Agostoni
- Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Anesthesia and Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Fumagalli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Department of Anesthesia and Intensive Care 1, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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7
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De Carlis R, Vella I, Incarbone N, Centonze L, Buscemi V, Lauterio A, De Carlis L. Impact of the COVID-19 pandemic on liver donation and transplantation: A review of the literature. World J Gastroenterol 2021; 27:928-938. [PMID: 33776364 PMCID: PMC7968133 DOI: 10.3748/wjg.v27.i10.928] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/01/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has upended healthcare systems worldwide and led to an inevitable decrease in liver transplantation (LT) activity. During the first pandemic wave, administrators and clinicians were obliged to make the difficult decision of whether to suspend or continue a life-saving procedure based on the scarce available evidence regarding the risk of transmission and mortality in immunosuppressed patients. Those centers where the activity continued or was heavily restricted were obliged to screen donors and recipients, design COVID-safe clinical pathways, and promote telehealth to prevent nosocomial transmission. Despite the ever-growing literature on COVID-19, the amount of high-quality literature on LT remains limited. This review will provide an updated view of the impact of the pandemic on LT programs worldwide. Donor and recipient screening, strategies for waitlist prioritization, and posttransplant risk of infection and mortality are discussed. Moreover, a particular focus is given to the possibility of donor-to-recipient transmission and immunosuppression management in COVID-positive recipients.
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Affiliation(s)
- Riccardo De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
| | - Ivan Vella
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
- Department of Surgical Sciences, University of Pavia, Pavia 27100, Italy
| | - Niccolò Incarbone
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan 20126, Italy
| | - Leonardo Centonze
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
| | - Vincenzo Buscemi
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
| | - Andrea Lauterio
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan 20126, Italy
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8
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Danziger-Isakov L, Blumberg EA, Manuel O, Sester M. Impact of COVID-19 in solid organ transplant recipients. Am J Transplant 2021; 21:925-937. [PMID: 33319449 PMCID: PMC9800718 DOI: 10.1111/ajt.16449] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/17/2020] [Accepted: 12/07/2020] [Indexed: 01/25/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exploded onto the world stage in early 2020. The impact on solid organ transplantation (SOT) has been profound affecting potential donors, candidates, and recipients. Importantly, decreased donations and the pressure of limited resources placed on health care by the pandemic also disrupted transplant systems. We address the impact of COVID-19 on organ transplantation globally and review current understanding of the epidemiology, outcomes, diagnosis, and treatment of COVID-19 in SOT recipients.
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Affiliation(s)
- Lara Danziger-Isakov
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio, USA
| | - Emily A. Blumberg
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Oriol Manuel
- Infectious Diseases Service and Transplantation Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Martina Sester
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
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9
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Solid Organ Transplantation During COVID-19 Pandemic: An International Web-based Survey on Resources' Allocation. Transplant Direct 2021; 7:e669. [PMID: 34113712 PMCID: PMC8184017 DOI: 10.1097/txd.0000000000001115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/31/2020] [Accepted: 11/07/2020] [Indexed: 02/06/2023] Open
Abstract
Supplemental Digital Content is available in the text. Solid organ transplants (SOTs) are life-saving interventions, recently challenged by coronavirus disease 2019 (COVID-19). SOTs require a multistep process, which can be affected by COVID-19 at several phases.
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10
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Waisberg DR, Abdala E, Nacif LS, Haddad LB, Ducatti L, Santos VR, Gouveia LN, Lazari CS, Martino RB, Pinheiro RS, Arantes RM, Terrabuio DR, Malbouisson LM, Galvao FH, Andraus W, Carneiro‐D'Albuquerque LA. Liver transplant recipients infected with SARS-CoV-2 in the early postoperative period: Lessons from a single center in the epicenter of the pandemic. Transpl Infect Dis 2021; 23:e13418. [PMID: 32667716 PMCID: PMC7404440 DOI: 10.1111/tid.13418] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/02/2020] [Accepted: 07/05/2020] [Indexed: 12/13/2022]
Abstract
The impact of coronavirus disease-19 (COVID-19) in liver recipients remains largely unknown. Most data derive from small retrospective series of patients transplanted years ago. We aimed to report a single-center case series of five consecutive patients in the early postoperative period of deceased-donor liver transplantation who developed nosocomial COVID-19. Two patients presented important respiratory discomfort and eventually died. One was 69 years old and had severe coronary disease. She rapidly worsened after COVID-19 diagnosis on 9th postoperative day. The other was 67 years old with non-alcoholic steatohepatitis, who experienced prolonged postoperative course, complicated with cytomegalovirus infection and kidney failure. He was diagnosed on 36th postoperative day and remained on mechanical ventilation for 20 days, ultimately succumbing of secondary bacterial infection. The third, fourth, and fifth patients were diagnosed on 10th, 11th, and 18th postoperative day, respectively, and presented satisfactory clinical evolution. These last two patients were severely immunosuppressed, since one underwent steroid bolus for acute cellular rejection and another also used anti-thymocyte globulin for treating steroid-resistant rejection. Our novel experience highlights that COVID-19 may negatively impact the postoperative course, especially in elder and obese patients with comorbidities, and draws attention to COVID-19 nosocomial spread in the early postoperative period.
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Affiliation(s)
- Daniel Reis Waisberg
- Liver and Abdominal Organs Transplantation DivisionDepartment of GastroenterologyHospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
- Laboratory of Medical Investigation 37 (LIM‐37)Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
| | - Edson Abdala
- Liver and Abdominal Organs Transplantation DivisionDepartment of GastroenterologyHospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
- Laboratory of Medical Investigation 37 (LIM‐37)Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
- Department of Infectious and Parasitic diseasesFaculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
| | - Lucas Souto Nacif
- Liver and Abdominal Organs Transplantation DivisionDepartment of GastroenterologyHospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
- Laboratory of Medical Investigation 37 (LIM‐37)Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
| | - Luciana Bertocco Haddad
- Liver and Abdominal Organs Transplantation DivisionDepartment of GastroenterologyHospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
- Laboratory of Medical Investigation 37 (LIM‐37)Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
| | - Liliana Ducatti
- Liver and Abdominal Organs Transplantation DivisionDepartment of GastroenterologyHospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
- Laboratory of Medical Investigation 37 (LIM‐37)Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
| | - Vinicius Rocha Santos
- Liver and Abdominal Organs Transplantation DivisionDepartment of GastroenterologyHospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
- Laboratory of Medical Investigation 37 (LIM‐37)Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
| | - Larissa Nunes Gouveia
- Liver and Abdominal Organs Transplantation DivisionDepartment of GastroenterologyHospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
- Department of Infectious and Parasitic diseasesFaculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
| | - Carolina Santos Lazari
- Division of Central LaboratoryHospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
| | - Rodrigo Bronze Martino
- Liver and Abdominal Organs Transplantation DivisionDepartment of GastroenterologyHospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
- Laboratory of Medical Investigation 37 (LIM‐37)Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
| | - Rafael Soares Pinheiro
- Liver and Abdominal Organs Transplantation DivisionDepartment of GastroenterologyHospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
- Laboratory of Medical Investigation 37 (LIM‐37)Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
| | - Rubens Macedo Arantes
- Liver and Abdominal Organs Transplantation DivisionDepartment of GastroenterologyHospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
- Laboratory of Medical Investigation 37 (LIM‐37)Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
| | - Debora Raquel Terrabuio
- Liver and Abdominal Organs Transplantation DivisionDepartment of GastroenterologyHospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
- Laboratory of Medical Investigation 37 (LIM‐37)Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
| | - Luiz Marcelo Malbouisson
- Liver and Abdominal Organs Transplantation DivisionDepartment of GastroenterologyHospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
| | - Flavio Henrique Galvao
- Liver and Abdominal Organs Transplantation DivisionDepartment of GastroenterologyHospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
- Laboratory of Medical Investigation 37 (LIM‐37)Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
| | - Wellington Andraus
- Liver and Abdominal Organs Transplantation DivisionDepartment of GastroenterologyHospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
- Laboratory of Medical Investigation 37 (LIM‐37)Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
| | - Luiz Augusto Carneiro‐D'Albuquerque
- Liver and Abdominal Organs Transplantation DivisionDepartment of GastroenterologyHospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
- Laboratory of Medical Investigation 37 (LIM‐37)Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HC‐FMUSP)São PauloBrazil
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11
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Affiliation(s)
| | - Darius F. Mirza
- Address for correspondence: Darius F. Mirza, Consultant HPB and Transplant surgeon, The Liver Unit, 3rd Floor, Nuffield House Queen Elizabeth Hospital, Mindelsohn Way, Brimingham B15 2TH, United Kingdom.
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12
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Roccato M, Cavazza N, Colloca P, Russo S. A Democratic Emergency After a Health Emergency? Exposure to COVID-19, Perceived Economic Threat and Support for Anti-Democratic Political Systems. SOCIAL SCIENCE QUARTERLY 2020; 101:2193-2202. [PMID: 33041377 PMCID: PMC7537510 DOI: 10.1111/ssqu.12865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/23/2020] [Indexed: 05/18/2023]
Abstract
OBJECTIVES The urgency of the COVID-19 pandemic has led governments to impose restrictions on individual freedom and required citizens to comply with these restrictions. In addition, lockdowns related to COVID-19 have led to a significant economic crisis. We aimed to study how the pandemic and related economic threats have impacted support for anti-democratic political systems. METHOD We analyzed data from a quota panel of the Italian adult population (N = 1,195), surveyed once before and once during the pandemic. RESULTS A hierarchical regression model showed that exposure to COVID-19 and perceived economic insecurity were associated with support for anti-democratic political systems, independent of participants' predispositions toward a strong leader. CONCLUSION An authoritarian personality is not a necessary precondition for individual anti-democracy: when facing severe personal threats, anyone could restore a subjective sense of control over the social world by becoming anti-democratic, independent of their initial predisposition to support anti-democratic political systems.
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13
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Mangioni D, Dondossola D, Antonelli B, Alagna L, Invernizzi F, Polli F, Tosetti G, Muscatello A, Gori A, Rossi G. Coronavirus disease 2019 and transplantation: tackling the challenges of SARS-CoV-2 infection in waiting list candidates. Transpl Int 2020; 33:1830-1832. [PMID: 32936963 DOI: 10.1111/tri.13742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Davide Mangioni
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Daniele Dondossola
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Barbara Antonelli
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Alagna
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Invernizzi
- Division of Gastroenterology and Hepatology - CRC "A. M. and A. Migliavacca", Center for the Study of Liver Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federico Polli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Tosetti
- Division of Gastroenterology and Hepatology - CRC "A. M. and A. Migliavacca", Center for the Study of Liver Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Muscatello
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giorgio Rossi
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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14
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Polak WG, Fondevila C, Karam V, Adam R, Baumann U, Germani G, Nadalin S, Taimr P, Toso C, Troisi RI, Zieniewicz K, Belli LS, Duvoux C. Impact of COVID-19 on liver transplantation in Europe: alert from an early survey of European Liver and Intestine Transplantation Association and European Liver Transplant Registry. Transpl Int 2020; 33:1244-1252. [PMID: 32609908 PMCID: PMC7361228 DOI: 10.1111/tri.13680] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/25/2020] [Accepted: 06/22/2020] [Indexed: 12/11/2022]
Abstract
There are scarce data on the impact of COVID‐19 pandemic on liver transplantation (LT) in Europe. The aim of this study was to obtain a preliminary data on incidence, management, and outcome of COVID‐19 in liver transplant recipients and candidates in Europe. An Internet‐based survey was sent to the centers affiliated with European Liver Transplant Registry (ELTR). One hundred nine out of 149 (73%) of ELTR centers located in 28 European countries (93%) responded. Ninety‐four (86%) of the centers tested all donors, and 75 (69%) centers tested all LT recipients for SARS‐CoV‐2. Seventy‐three (67%) centers selected recipients for LT in the COVID‐19 pandemic, whereas 33% did not. Eighty‐eight centers reported COVID‐19 infection in 57 LT candidates and in 272 LT recipients. Overall crude incidence of COVID‐19 among LT candidates and recipients was estimated 1.05% (range 0.5–20%) and 0.34% (range 0.1–4.8%), respectively, and it was significantly higher among candidates (P < 0.001). Crude rate of death was 18% (10/57) among candidates and 15% (36/244) among recipients. This first large‐scale European snapshot study clearly shows that both LT candidates and recipients are at a high risk for COVID‐19. These results plead for an early and pro‐active screening of COVID‐19 symptoms in these populations.
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Affiliation(s)
- Wojciech G Polak
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Constantino Fondevila
- Liver Transplant Unit, Department of General and Digestive Surgery, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Vincent Karam
- Department of European Liver Transplant Registry, Centre Hépatobiliaire, Hôpital Universitaire, Paul Brousse, Villejuif, France
| | - Rene Adam
- Department of Hepatobiliary Surgery, Cancer and Transplantation, AP-HP Hôpital Universitaire Paul Brousse, Villejuif, France
| | - Ulrich Baumann
- Division of Paediatric Gastroenterology and Hepatology, Department of Paediatric Kidney-, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.,Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Giacomo Germani
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Pavel Taimr
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Christian Toso
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Roberto I Troisi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Luca S Belli
- Division of Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Christophe Duvoux
- Medical Liver Transplant Unit and Liver Department, Henri Mondor Hospital AP-HP, Paris Est University, Créteil, France
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15
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Taneja S, Mehtani R, Chawla YK. Gastrointestinal and Liver Manifestations of COVID-19. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2020. [DOI: 10.1055/s-0040-1713837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AbstractA novel Coronavirus, SARS-CoV-2 illness, has spread throughout the world after the first case was reported from Wuhan, China, in December 2019. This illness typically causes respiratory symptoms like fever, cough, and shortness of breath, although atypical presentation with gastrointestinal symptoms like abdominal pain, nausea, vomiting, or diarrhea are being increasingly reported. The viral RNA has been detected in saliva and stool of such patients, which raises concerns regarding the risk of transmission during gastrointestinal (GI) endoscopy. Many patients also have liver involvement, with the most common manifestation being deranged liver function tests. This review highlights the symptomatology, mechanism, and histopathology findings of SARS-CoV-2 in GI tract and liver. This review also focuses on implications of COVID-19 in patients afflicted with chronic liver disease and in patients undergoing liver transplantation.
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Affiliation(s)
- Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Rohit Mehtani
- Department of Hepatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Yogesh Kumar Chawla
- Department of Gastroenterology, Kalinga Institute of Medical Sciences, Bhuvneshwar, India
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16
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Cannavò A, Passamonti SM, Martinuzzi D, Longobardi A, Fiorattini A, Troni NM, Esposito MH, Dell'orefice N, Torelli R, De Feo TM. The Impact of COVID-19 on Solid Organ Donation: The North Italy Transplant Program Experience. Transplant Proc 2020; 52:2578-2583. [PMID: 32709414 PMCID: PMC7316055 DOI: 10.1016/j.transproceed.2020.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 12/26/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) outbreak has unfavorably influenced solid organ donation activity. Aim The aim of this study is to investigate the effect of COVID-19 on transplantation in the North Italy Transplant program (NITp). Material and Methods This cross-sectional study included all consecutive potential deceased donors proposed in the NITp in 6 weeks after February 21, 2020 (period A) compared to all potential donors during the same time frame of the previous years (period B) and all potential donors 6 weeks before February 20, 2020 (period C). Results Fifty-eight deceased donors were proposed during period A, 95 were proposed during period B, and 128 were proposed during period C. After the evaluation process, 32 of 58 (55.2%), 60 of 95 (63.2%), and 79 of 128 (61.7%) donors were used for organ donation in periods A, B, and C, respectively (P value = .595). We observed a 47% donation reduction in period A compared to period B and a 60% reduction compared to period C. There was a reduction of 44% and 59% in transplantation comparing period A with period B and period C, respectively. Conclusions This study showed an important reduction of donations and transplants during the COVID-19 pandemic.
Coronavirus disease 2019 (COVID-19) outbreak has unfavorably influenced the overall donation activity. We observed a 47% to 60% donation reduction during the outbreak period. Donors' decrease led to a 44% to 59% reduction in transplant activity.
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Affiliation(s)
- Antonino Cannavò
- Unità Operativa Complessa (UOC) Coordinamento Trapianti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
| | - Serena Maria Passamonti
- Unità Operativa Complessa (UOC) Coordinamento Trapianti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Martinuzzi
- Unità Operativa Complessa (UOC) Coordinamento Trapianti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Longobardi
- Unità Operativa Complessa (UOC) Coordinamento Trapianti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Fiorattini
- Unità Operativa Complessa (UOC) Coordinamento Trapianti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicoletta Margherita Troni
- Unità Operativa Complessa (UOC) Coordinamento Trapianti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Martha Helena Esposito
- Unità Operativa Complessa (UOC) Coordinamento Trapianti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicolina Dell'orefice
- Unità Operativa Complessa (UOC) Coordinamento Trapianti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosanna Torelli
- Unità Operativa Complessa (UOC) Coordinamento Trapianti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Tullia Maria De Feo
- Unità Operativa Complessa (UOC) Coordinamento Trapianti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
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17
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Boffini M, Pidello S, Simonato E, Barbero C, Attisani M, Trompeo A, De Ferrari GM, Rinaldi M. An effective protocol for heart transplantation during COVID-19 outbreak. Transpl Int 2020; 33:1326-1328. [PMID: 32512629 DOI: 10.1111/tri.13674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Massimo Boffini
- Cardiac Surgery Division, Surgical Sciences Department, Heart and Lung Transplant Center, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy
| | - Stefano Pidello
- Cardiology Division, Medical Sciences Department, Heart and Lung Transplant Center, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy
| | - Erika Simonato
- Cardiac Surgery Division, Surgical Sciences Department, Heart and Lung Transplant Center, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy
| | - Cristina Barbero
- Cardiac Surgery Division, Surgical Sciences Department, Heart and Lung Transplant Center, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy
| | - Matteo Attisani
- Cardiac Surgery Division, Surgical Sciences Department, Heart and Lung Transplant Center, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy
| | - Anna Trompeo
- Cardiac Surgery Division, Surgical Sciences Department, Heart and Lung Transplant Center, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy
| | - Gaetano Maria De Ferrari
- Cardiology Division, Medical Sciences Department, Heart and Lung Transplant Center, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy
| | - Mauro Rinaldi
- Cardiac Surgery Division, Surgical Sciences Department, Heart and Lung Transplant Center, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy
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18
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Berardi G, Colasanti M, Levi Sandri GB, Del Basso C, Ferretti S, Laurenzi A, Guglielmo N, Meniconi RL, Antonini M, D'Offizi G, Ettorre GM. Continuing our work: transplant surgery and surgical oncology in a tertiary referral COVID-19 center. Updates Surg 2020; 72:281-289. [PMID: 32500431 PMCID: PMC7271142 DOI: 10.1007/s13304-020-00825-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/28/2020] [Indexed: 01/01/2023]
Abstract
COVID-19 is rapidly spreading worldwide. Healthcare systems are struggling to properly allocate resources while ensuring cure for diseases outside of the infection. The aim of this study was to demonstrate how surgical activity was affected by the virus outbreak and show the changes in practice in a tertiary referral COVID-19 center. The official bulletins of the Italian National Institute for the Infectious Diseases "L. Spallanzani" were reviewed to retrieve the number of daily COVID-19 patients. Records of consecutive oncological and transplant procedures performed during the outbreak were reviewed. Patients with a high probability of postoperative intensive care unit (ICU) admission were considered as high risk and defined by an ASA score ≥ III and/or a Charlson Comorbidity Index (CCI) ≥ 6 and/or a Revised Cardiac Risk Index for Preoperative Risk (RCRI) ≥ 3. 72 patients were operated, including 12 (16.6%) liver and kidney transplantations. Patients had few comorbidities (26.3%), low ASA score (1.9 ± 0.5), CCI (3.7 ± 1.3), and RCRI (1.2 ± 0.6) and had overall a low risk of postoperative ICU admission. Few patients had liver cirrhosis (12.5%) or received preoperative systemic therapy (16.6%). 36 (50%) high-risk surgical procedures were performed, including major hepatectomies, pancreaticoduodenectomies, total gastrectomies, multivisceral resections, and transplantations. Despite this, only 15 patients (20.8%) were admitted to the ICU. Only oncologic cases and transplantations were performed during the COVID-19 outbreak. Careful selection of patients allowed to perform major cancer surgeries and transplantations without further stressing hospital resources, meanwhile minimizing collateral damage to patients.
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Affiliation(s)
- Giammauro Berardi
- Department of General Surgery and Liver Transplantation Service, San Camillo Forlanini, Italian National Institute for the Infectious Diseases "L. Spallanzani", Via Giacomo Folchi 6A, Rome, Italy.
| | - Marco Colasanti
- Department of General Surgery and Liver Transplantation Service, San Camillo Forlanini, Italian National Institute for the Infectious Diseases "L. Spallanzani", Via Giacomo Folchi 6A, Rome, Italy
| | - Giovanni Battista Levi Sandri
- Department of General Surgery and Liver Transplantation Service, San Camillo Forlanini, Italian National Institute for the Infectious Diseases "L. Spallanzani", Via Giacomo Folchi 6A, Rome, Italy
| | - Celeste Del Basso
- Department of General Surgery and Liver Transplantation Service, San Camillo Forlanini, Italian National Institute for the Infectious Diseases "L. Spallanzani", Via Giacomo Folchi 6A, Rome, Italy
| | - Stefano Ferretti
- Department of General Surgery and Liver Transplantation Service, San Camillo Forlanini, Italian National Institute for the Infectious Diseases "L. Spallanzani", Via Giacomo Folchi 6A, Rome, Italy
| | - Andrea Laurenzi
- Department of General Surgery and Liver Transplantation Service, San Camillo Forlanini, Italian National Institute for the Infectious Diseases "L. Spallanzani", Via Giacomo Folchi 6A, Rome, Italy
| | - Nicola Guglielmo
- Department of General Surgery and Liver Transplantation Service, San Camillo Forlanini, Italian National Institute for the Infectious Diseases "L. Spallanzani", Via Giacomo Folchi 6A, Rome, Italy
| | - Roberto Luca Meniconi
- Department of General Surgery and Liver Transplantation Service, San Camillo Forlanini, Italian National Institute for the Infectious Diseases "L. Spallanzani", Via Giacomo Folchi 6A, Rome, Italy
| | - Mario Antonini
- Department of Intensive Care and Anesthesiology, San Camillo Forlanini, Italian National Institute for the Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Gianpiero D'Offizi
- Department of Infectious Diseases, Italian National Institute for the Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Giuseppe Maria Ettorre
- Department of General Surgery and Liver Transplantation Service, San Camillo Forlanini, Italian National Institute for the Infectious Diseases "L. Spallanzani", Via Giacomo Folchi 6A, Rome, Italy
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