Solid Organ Transplantation in the Era of COVID-19: Lessons from France

Zaidan, Mohamad; Legendre, Christophe

doi:10.1097/tp.0000000000003536

Cited by 28 publications

(38 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We found that, of our KTRs who reported a household contact with a known Covid-19 case, 34% had anti-SARS-CoV-2 antibodies. Because a similar frequency was described in the Spanish serosurvey (37.4%), 2 we believe that active prevention and control measures to limit virus spread should be vigorously implemented for the KTR population.…”

Section: Discussionsupporting

confidence: 70%

SARS-Cov-2 Seroprevalence in a French Kidney Transplant Center Located Within a “High-risk” Zone

et al. 2021

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 70%

SARS-Cov-2 Seroprevalence in a French Kidney Transplant Center Located Within a “High-risk” Zone

et al. 2021

View full text Add to dashboard Cite

show abstract

“…1,2 Despite the urgent need for many waitlisted patients worldwide to receive transplants, preliminary data suggest substantial reductions in transplantation procedures in some countries since the COVID-19 outbreak. [3][4][5][6][7][8][9][10][11] However, there is a paucity of available data concerning the effects of the pandemic on worldwide transplantation rates and how transplantation policies have changed in response to risk of infection and death associated with COVID-19. [12][13][14] The consequences of COVID-19 are not only due to infectious deaths but also the impact of the pandemic on diverse health-care services, including disruptions to or delays in cancer treatment.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 pandemic and worldwide organ transplantation: a population-based study

Aubert¹,

Yoo²,

Zielinski³

et al. 2021

The Lancet Public Health

179

162

View full text Add to dashboard Cite

Background Preliminary data suggest that COVID-19 has reduced access to solid organ transplantation. However, the global consequences of the COVID-19 pandemic on transplantation rates and the effect on waitlisted patients have not been reported. We aimed to assess the effect of the COVID-19 pandemic on transplantation and investigate if the pandemic was associated with heterogeneous adaptation in terms of organ transplantation, with ensuing consequences for waitlisted patients.Methods In this population-based, observational, before-and-after study, we collected and validated nationwide cohorts of consecutive kidney, liver, lung, and heart transplants from 22 countries. Data were collected from Jan 1 to Dec 31, 2020, along with data from the same period in 2019. The analysis was done from the onset of the 100th cumulative COVID-19 case through to Dec 31, 2020. We assessed the effect of the pandemic on the worldwide organ transplantation rate and the disparity in transplant numbers within each country. We estimated the number of waitlisted patient life-years lost due to the negative effects of the pandemic. The study is registered with ClinicalTrials.gov, NCT04416256.Findings Transplant activity in all countries studied showed an overall decrease during the pandemic. Kidney transplantation was the most affected, followed by lung, liver, and heart. We identified three organ transplant rate patterns, as follows: countries with a sharp decrease in transplantation rate with a low COVID-19-related death rate; countries with a moderate decrease in transplantation rate with a moderate COVID-19-related death rate; and countries with a slight decrease in transplantation rate despite a high COVID-19-related death rate. Temporal trends revealed a marked worldwide reduction in transplant activity during the first 3 months of the pandemic, with losses stabilising after June, 2020, but decreasing again from October to December, 2020. The overall reduction in transplants during the observation time period translated to 48 239 waitlisted patient life-years lost.Interpretation We quantified the impact of the COVID-19 pandemic on worldwide organ transplantation activity and revealed heterogeneous adaptation in terms of organ transplantation, both at national levels and within countries, with detrimental consequences for waitlisted patients. Understanding how different countries and health-care systems responded to COVID-19-related challenges could facilitate improved pandemic preparedness, notably, how to safely maintain transplant programmes, both with immediate and non-immediate life-saving potential, to prevent loss of patient life-years.

show abstract

“…While no specific data from trials including transplant recipients with COVID-19 have been published so far, concerns have been raised on the off-label and potentially harmful use of targeted therapies. 12,13 Several variabilities also exist in managing immunosuppression. In the United States, centers were less likely to administer T-cell depleting agents (TDA) for induction.…”

mentioning

confidence: 99%

“…14 In terms of maintenance immunosuppression, depending on the patient's symptoms, a stepwise reduction in immunosuppression is recommended. 1,12,[14][15][16] There is a dearth of literature in practices related to non-hospitalized transplant recipients with COVID-19 and prevalent transplant recipients.…”

mentioning

confidence: 99%

Immunosuppression practices during the COVID‐19 pandemic: A multinational survey study of transplant programs

Sandal

Boyarsky

Massie

et al. 2021

Clinical Transplantation

View full text Add to dashboard Cite

During the COVID‐19 pandemic, there has been wide heterogeneity in the medical management of transplant recipients. We aimed to pragmatically capture immunosuppression practices globally following the early months of the pandemic. From June to September 2020, we surveyed 1267 physicians; 40.5% from 71 countries participated. Management decisions were made on a case‐by‐case basis by the majority (69.6%) of the programs. Overall, 76.8% performed ≥1 transplantation and many commented on avoiding high‐risk transplantations. For induction, 26.5% were less likely to give T‐cell depletion and 14.8% were more likely to give non‐depleting agents. These practices varied by program‐level factors more so than the COVID‐19 burden. In patients with mild, moderate and severe COVID‐19 symptoms 59.7%, 76.0%, and 79.5% decreased/stopped anti‐metabolites, 23.2%, 45.4%, and 68.2% decreased/stopped calcineurin inhibitors, and 25.7%, 43.9%, and 57.7% decreased/stopped mTOR inhibitors, respectively. Also, 2.1%, 30.6%, and 46.0% increased steroids in patients with mild, moderate, and severe COVID‐19 symptoms. For prevalent transplant recipients, some programs also reported decreasing/stopping steroids (1.8%), anti‐metabolites (10.3%), calcineurin inhibitors (4.1%), and mTOR inhibitors (5.5%). Transplant programs changed immunosuppression practices but also avoided high‐risk transplants and increased maintenance steroids. The long‐term ramifications of these practices remain to be seen as programs face the aftermath of the pandemic.

show abstract

Solid Organ Transplantation in the Era of COVID-19: Lessons from France

Cited by 28 publications

References 63 publications

SARS-Cov-2 Seroprevalence in a French Kidney Transplant Center Located Within a “High-risk” Zone

SARS-Cov-2 Seroprevalence in a French Kidney Transplant Center Located Within a “High-risk” Zone

COVID-19 pandemic and worldwide organ transplantation: a population-based study

Immunosuppression practices during the COVID‐19 pandemic: A multinational survey study of transplant programs

Contact Info

Product

Resources

About