Early impact of COVID-19 on transplant center practices and policies in the United States

Abstract

COVID-19 is a novel, rapidly changing pandemic: consequently, evidence-based recommendations in solid organ transplantation (SOT) remain challenging and unclear. To understand the impact on transplant activity across the United States, and center-level variation in testing, clinical practice, and policies, we conducted a national survey between March 24, 2020 and March 31, 2020 and linked responses to the COVID-19 incidence map. Response rate was a very high 79.3%, reflecting a strong national priority to better understand COVID-19. Complete suspension of live donor kidney transplantation was reported by 71.8% and live donor liver by 67.7%.While complete suspension of deceased donor transplantation was less frequent, some restrictions to deceased donor kidney transplantation were reported by 84.0% and deceased donor liver by 73.3%; more stringent restrictions were associated with higher regional incidence of COVID-19. Shortage of COVID-19 tests was reported by 42.5%. Respondents reported a total of 148 COVID-19 recipients from <1 to >10 years posttransplant: 69.6% were kidney recipients, and 25.0% were critically ill. Hydroxychloroquine (HCQ) was used by 78.1% of respondents; azithromycin by 46.9%; tocilizumab by 31.3%, and remdesivir by 25.0%. There is wide heterogeneity in center-level response across the United States; ongoing national data collection, expert discussion, and clinical studies are critical to informing evidence-based practices. K E Y W O R D Sclinical decision-making, epidemiology, guidelines, infectious agents-viral

COVID-19: implications for immunosuppression in kidney disease and transplantation

“…Likewise, transplantation programmes have been suspended in various countries because of scarce resources (especially ICU beds) and concerns regarding the unforeseeable consequences of common immunosuppressive induction regimens. In the USA, 71.8% of surveyed physi cians reported full suspension of live donation kidney transplant programmes, and 80.2% of deceased donor kidney transplant programmes were operating with restrictions 10 . In Austria, the transplantation programme was reinitiated on 14 April 2020, but limited to kidney transplants (live and deceased donor) with low immuno logical risk that do not require anti-thymoglobulin or alemtuzumab induction regimens.…”

The role of passive immunization in the age of SARS-CoV-2: an update

“…In a retrospective cohort study from Wuhan, Zhang [27] There are currently no data available about a clinical benefit of passive immunization, though translation of current knowledge for organ transplant patients seems to favor for this treatment. This strategy seems to be even more important knowing that 72% of US centers have suspended live donor kidney transplantation and 68% live donor liver transplantation [28]. Therefore, prospective randomized trials are necessary if passive immunization is a treatment option.…”

Response to “The COVID-19 outbreak in Italy: Initial implications for organ transplantation programs”

“…It is notable that another study reported in the United States restricted SOT, with >70% of U.S. TxCs having suspended living donor kidney transplantation (LDKT). 2 The impact of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) on LDKT in Italy is mentioned only briefly in the article. 1 However, it should be a matter of careful consideration, as the Italian NRB reported since 2015 an increment of only 0.6/per milion population 3,4 ( Figure 1A).…”