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Yang J, Endo Y, Sasaki K, Schenk A, Pawlik TM. Chronological and Geographical Variations in the Incidence and Acceptance of COVID-19-Positive Donors and Outcomes Among Abdominal Transplant Patients. Clin Transplant 2024; 38:e15391. [PMID: 38967586 DOI: 10.1111/ctr.15391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/26/2024] [Accepted: 06/11/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Given the importance of understanding COVID-19-positive donor incidence and acceptance, we characterize chronological and geographic variations in COVID-19 incidence relative to COVID-19-positive donor acceptance. METHODS Data on deceased donors and recipients of liver and kidney transplants were obtained from the UNOS database between 2020 and 2023. Hierarchical cluster analysis was used to assess trends in COVID-19-positive donor incidence. Posttransplant graft and patient survival were assessed using Kaplan-Meier curves. RESULTS From among 38 429 deceased donors, 1517 were COVID-19 positive. Fewer kidneys (72.4% vs. 76.5%, p < 0.001) and livers (56.4% vs. 62.0%, p < 0.001) were used from COVID-19-positive donors versus COVID-19-negative donors. Areas characterized by steadily increased COVID-19 donor incidence exhibit the highest transplantation acceptance rates (92.33%), followed by intermediate (84.62%) and rapidly increased (80.00%) COVID-19 incidence areas (p = 0.016). Posttransplant graft and patient survival was comparable among recipients, irrespective of donor COVID-19 status. CONCLUSIONS Regions experiencing heightened rates of COVID-19-positive donors are associated with decreased acceptance of liver and kidney transplantation. Similar graft and patient survival is noted among recipients, irrespective of donor COVID-19 status. These findings emphasize the need for adaptive practices and unified medical consensus in navigating a dynamic pandemic.
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Affiliation(s)
- Jason Yang
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Kazunari Sasaki
- Department of Surgery, Stanford University, Stanford, California, USA
| | - Austin Schenk
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
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2
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Chih S, Clarke BA, Albert M, Buchan CA, Kafil TS, Kim DH, Kumar D, Smith SJ, Solera Rallo JT, Stubbs MJ, McDonald MA. The COVID-19 Pandemic and Adult Cardiac Transplantation: Impact, Interventions, and Implications. Can J Cardiol 2023; 39:853-864. [PMID: 36965667 PMCID: PMC10035809 DOI: 10.1016/j.cjca.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/27/2023] Open
Abstract
In this review, we provide a comprehensive overview of the impact of the COVID-19 pandemic on adult heart transplantation. We highlight the decline in the number of adult transplantations performed throughout the pandemic as a consequence of restrictions imposed on individual programs and hospitals. There were challenges to maintaining cardiac transplant activity at multiple levels, including organ donation in intensive care units, logistical difficulties with organ procurement, and rapidly changing resource considerations at health system and jurisdictional levels. We also review the impact of COVID-19 on cardiac transplant recipients. Despite the high rates of morbidity and mortality observed during the initial phases of the pandemic among heart transplant patients infected with COVID-19, the availability of effective vaccines, pre-exposure prophylaxis, and specific antiviral therapies have drastically improved outcomes over time. Vaccines have proven to be safe and effective in reducing infections and illness severity, but specific considerations in the immunocompromised solid organ transplant population apply, including the need for additional booster doses to achieve sufficient immunisation. We further outline the strong rationale for vaccination before transplantation wherever possible. Finally, the COVID-19 response created a number of barriers to safe and efficient post-transplantation care. Given the need for frequent evaluation and monitoring, especially in the first several months after cardiac transplantation, the pandemic provided the impetus to improve virtual care delivery and explore noninvasive rejection surveillance through gene expression profiling. We hope that lessons learned will allow us to prepare and pivot effectively during future pandemics and health care emergencies.
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Affiliation(s)
- Sharon Chih
- Division of Cardiology, Heart Failure, and Transplantation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Brian A Clarke
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Albert
- Department of Medicine and Critical Care, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; CIUSSS-NIM Research Centre, Department of Surgery, Montréal Heart Institute, Montréal, Québec, Canada; Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - C Arianne Buchan
- Division of Infectious Diseases, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Canada, Ottawa, Ontario, Canada
| | - Tahir S Kafil
- Division of Cardiology, Heart Failure, and Transplantation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Daniel H Kim
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Canada
| | - Deepali Kumar
- Division of Infectious Disease, Transplant Infectious Disease, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stuart J Smith
- Division of Cardiology, London Health Sciences Centre, Western University, London, Canada
| | - Javier Tomas Solera Rallo
- Division of Infectious Disease, Transplant Infectious Disease, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michael J Stubbs
- Division of Cardiology, University Health Network, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michael A McDonald
- Division of Cardiology, University Health Network, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada.
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Marcon AR, Zenone M, Caulfield T. The portrayal of organ donation on TikTok: A content analysis of popular English-language TikTok videos. Digit Health 2023; 9:20552076231222422. [PMID: 38152444 PMCID: PMC10752038 DOI: 10.1177/20552076231222422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023] Open
Abstract
Objective TikTok is one of the most popular social media platforms and plays a role in shaping public perceptions. This research examined how organ donation was portrayed on the platform. Methods We built a dataset of the most popular English-language TikTok videos that used the hashtags #organdonor or #organdonation. We then performed content analysis on the 400 most viewed videos after limiting data set inclusion to one video per user account. Results The finalized videos (N = 313) had generated nearly 80 million views and 10 million likes. Featuring both donors (56.2%) and recipients (44.1%), videos shared experiences that celebrated and lamented lost donor lives (41.8%) while also celebrating transplantation successes (31.3%). Very few videos included public solicitation (2.9%). Common video traits included detailing medical procedures (45.4%), presenting honor walks (10.9%), and displaying donors and recipients connecting or wanting to connect (16.9%). Videos mostly had a positive (74.1%) versus negative (10.2%) leaning tone. Conclusion Far from superficially glamorizing organ donation/transplantation processes and procedures, popular English-language TikTok videos depicted what we perceived as highly emotional and expository experiences. While the videos likely offered learning and cathartic opportunities for individuals and communities, they also highlight some tensions between personal anecdotes and data/research. Findings from this research can inform public outreach efforts as well as policies related to protecting anonymity and celebrating donors with honor walks. Indeed, given TikTok's increasing popularity and influence, it could be a valuable tool to meaningfully learn from, and engage with, patient and donor communities.
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Affiliation(s)
- Alessandro R Marcon
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Alberta, Canada
| | - Marco Zenone
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Alberta, Canada
| | - Timothy Caulfield
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Alberta, Canada
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4
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Dafoe TJ, Dos Santos T, Spigelman AF, Lyon J, Smith N, Bautista A, MacDonald PE, Manning Fox JE. Impacts of the COVID-19 pandemic on a human research islet program. Islets 2022; 14:101-113. [PMID: 35285768 PMCID: PMC8928860 DOI: 10.1080/19382014.2022.2047571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
Designated a pandemic in March 2020, the spread of severe acute respiratory syndrome virus 2 (SARS-CoV2), the virus responsible for coronavirus disease 2019 (COVID-19), led to new guidelines and restrictions being implemented for individuals, businesses, and societies in efforts to limit the impacts of COVID-19 on personal health and healthcare systems. Here we report the impacts of the COVID-19 pandemic on pancreas processing and islet isolation/distribution outcomes at the Alberta Diabetes Institute IsletCore, a facility specializing in the processing and distribution of human pancreatic islets for research. While the number of organs processed was significantly reduced, organ quality and the function of cellular outputs were minimally impacted during the pandemic when compared to an equivalent period immediately prior. Despite the maintained quality of isolated islets, feedback from recipient groups was more negative. Our findings suggest this is likely due to disrupted distribution which led to increased transit times to recipient labs, particularly those overseas. Thus, to improve overall outcomes in a climate of limited research islet supply, prioritization of tissue recipients based on likely tissue transit times may be needed.
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Affiliation(s)
- Tina J. Dafoe
- Alberta Diabetes Institute IsletCore and Department of Pharmacology, University of Alberta, Edmonton, Alberta, Canada
| | - Theodore Dos Santos
- Alberta Diabetes Institute IsletCore and Department of Pharmacology, University of Alberta, Edmonton, Alberta, Canada
| | - Aliya F. Spigelman
- Alberta Diabetes Institute IsletCore and Department of Pharmacology, University of Alberta, Edmonton, Alberta, Canada
| | - James Lyon
- Alberta Diabetes Institute IsletCore and Department of Pharmacology, University of Alberta, Edmonton, Alberta, Canada
| | - Nancy Smith
- Alberta Diabetes Institute IsletCore and Department of Pharmacology, University of Alberta, Edmonton, Alberta, Canada
| | - Austin Bautista
- Alberta Diabetes Institute IsletCore and Department of Pharmacology, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick E. MacDonald
- Alberta Diabetes Institute IsletCore and Department of Pharmacology, University of Alberta, Edmonton, Alberta, Canada
| | - Jocelyn E. Manning Fox
- Alberta Diabetes Institute IsletCore and Department of Pharmacology, University of Alberta, Edmonton, Alberta, Canada
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Plummer NR, Alcock H, Madden S, Brander J, Manara A, Harvey DJ, Gardiner DC. The impact of COVID-19 on organ donation and transplantation in the UK: lessons learned from the first year of the pandemic. Anaesthesia 2022; 77:1237-1250. [PMID: 36099651 DOI: 10.1111/anae.15833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 12/01/2022]
Abstract
The COVID-19 pandemic had a major impact on UK deceased organ donation and transplantation activity. We used national audit data from NHS Blood and Transplant to explore in detail the effects of the pandemic in comparison with 12 months pre-pandemic, and to consider the impact of the mitigating strategies and challenges placed on ICU by 'waves' of patients with COVID-19. Between 11 March 2020 and 10 March 2021, referrals to NHS Blood and Transplant of potential organ donors were initially inversely related to the number of people with COVID-19 undergoing mechanical ventilation in intensive care (incident rate ratio (95%CI) per 1000 patients 0.93 (0.88-0.99), p = 0.018), although this pattern reversed during the second wave (additional incident rate ratio (95%CI) 1.12 (1.05-1.19), p < 0.001). Adjusted numbers of donors (incident rate ratio (95%CI) 0.71 (0.61-0.81), p < 0.001) and organs retrieved (incident rate ratio (95%CI) 0.89 (0.82-0.97), p = 0.007) were inversely dependent on COVID-19 workload, though weekly numbers of transplants were unrelated (incident rate ratio (95%CI) 0.95 (0.86-1.04), p = 0.235). Non-COVID-19 mortality fell from 15,007 to 14,087 during the first wave (rate ratio (95%CI) 0.94 (0.92-0.96), p < 0.001) but climbed from 18,907 to 19,372 during the second wave (rate ratio (95%CI) 1.02 (1.00-1.05), p = 0.018). There were fewer in-hospital deaths from cardiac arrest and intracranial catastrophes throughout (rate ratio (95%CI) 0.83 (0.81-0.86), p < 0.001 and rate ratio (95%CI) 0.88 (0.85-0.91), p < 0.001, respectively). There were overall fewer eligible donors (n = 4282) when compared with pre-pandemic levels (n = 6038); OR (95%CI) 0.58 (0.51-0.66), p < 0.001. The total number of donations during the year fell from 1620 to 1140 (rate ratio (95%CI) 0.70 (0.65-0.76), p < 0.001), but the proportion of eligible donors who proceeded to donation (27%) was unchanged (OR (95%CI) 0.99 (0.91-1.08), p = 0.821). The reduction in donations and transplantation during the pandemic was multifactorial, but these data highlight the impact in the UK of a fall in eligible donors and an inverse relationship of referrals to COVID-19 workload. Despite the challenges faced, the foundations underpinning the UK deceased organ donation programme remained strong.
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Affiliation(s)
- N R Plummer
- Nottingham University Hospitals NHS Trust, Nottingham, UK.,East Midlands School of Anaesthesia, Health Education England East Midlands, Leicester, UK
| | - H Alcock
- East Midlands School of Anaesthesia, Health Education England East Midlands, Leicester, UK
| | - S Madden
- NHS Blood and Transplant, Bristol, UK
| | - J Brander
- NHS Blood and Transplant, Bristol, UK
| | - A Manara
- NHS Blood and Transplant, Bristol, UK.,North Bristol NHS Trust, Bristol, UK
| | - D J Harvey
- Nottingham University Hospitals NHS Trust, Nottingham, UK.,NHS Blood and Transplant, Bristol, UK
| | - D C Gardiner
- Nottingham University Hospitals NHS Trust, Nottingham, UK.,NHS Blood and Transplant, Bristol, UK
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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: 47] [Impact Index Per Article: 23.5] [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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7
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Katvan E, Cohen J, Ashkenazi T. Organ donation in the time of COVID-19: the Israeli experience one year into the pandemic—ethical and policy implications. Isr J Health Policy Res 2022; 11:6. [PMID: 35101144 PMCID: PMC8802285 DOI: 10.1186/s13584-022-00519-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 01/17/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose To present the response of the Israel National Transplantation Center (NTC) to the evolving challenge of COVID-19, the impact on deceased organ donation and living organ kidney donation during 2020, and resultant policy and ethical implications. Methods Data collected included (i) for deceased donors, the total number of potential organ donors, if hospitalized in ICU or general ward, cause of death, number of family authorizations and refusals, number of actual donors, number of organs transplanted/donor and total number of transplants performed; (ii) for living-kidney-donors (related or altruistic), the number of procedures performed; and (iii) the number of patients registered on the national organ waiting-list. Results Following the first case (February 2020), deceased organ donation continued uninterrupted. The total number of potential donors was similar to 2019 (181 vs. 189). However, the number of families approached for donation decreased significantly (P = 0.02). This may be attributed to COVID-19-imposed limitations including fewer brain death determinations due to limited possibilities for face-to-face donor coordinator-donor family interactions providing emotional support and visual explanations of the medical situation. Fewer donors were admitted to ICU (P = 0.1) and the number of organs retrieved/donor decreased (3.8/donor to 3.4/donor). The overall result was a decrease of 24.2% in the number of transplant procedures (306 vs. 232). Living kidney donation, initially halted, resumed in May and the total number of procedures increased compared to 2019 due to a significant increase in altruistic donations (P < 0.0001), while the number of related-living donations decreased. Conclusion This study of organ donation during a crisis has informed the introduction of policy changes in the NTC including the necessity to mobilize rapidly a “war room”, the use of innovative virtual tools for contact-less communication, and the importance of cooperation with hospital authorities in allocating scarce health-care resources. Finally, the pandemic highlighted and intensified ethical considerations, such as under what circumstances living kidney donation be continued in the face of uncertainty, and what information to provide to altruistic donors regarding a prospective recipient, in particular whether all options for related living donation have been exhausted. These should be addressed now.
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8
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Ganapathi AM, Henn MC, Lampert BC, Nunley DR, Bumgardner G, Mokadam NA, Whitson BA. Thoracic transplantation during the COVID-19 pandemic. Clin Transplant 2021; 36:e14575. [PMID: 34964517 DOI: 10.1111/ctr.14575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 12/12/2021] [Accepted: 12/16/2021] [Indexed: 12/01/2022]
Abstract
The worldwide pandemic caused by COVID-19, resulting from the infection by betacoronarvirus SARS-CoV-2, has dramatically altered healthcare worldwide. Due to the highly contagious nature of SARS-CoV2, coupled with hospitals and intensive care units being overwhelmed, numerous transplant programs either slowed or shut down completely. While there have been isolated reports of COVID-19 in transplant recipients, no study to date has examined how COVID-19 affected actual transplant patterns and outcomes in the United States. Of particular importance is the impact of COVID-19 on mortality in waitlisted patients and transplant recipients. Using the Scientific Registry of Transplant Recipients (SRTR) dataset we compared waitlist and transplant characteristics from 3/2019-8/2019 to 3/2020-8/2020, as well as COVID-19 associated mortality in patients with prior heart or lung transplant or those active on the waitlist. Overall, there was an initial decrease in transplant volume in April 2020; however, volumes have normalized since then, with comparable outcomes to similar calendar months in 2019. Additionally, there were no significant changes in post-transplant outcomes or waiting list mortality. Given the ongoing COVID-19 pandemic it would be beneficial to maintain current practices for thoracic transplantation, to continue to provide this life-saving therapy to those in need. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Asvin M Ganapathi
- Divison of Cardiac Surgery, Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio
| | - Matthew C Henn
- Divison of Cardiac Surgery, Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio
| | - Brent C Lampert
- Division of Cardiology, Department of Medicine, The Ohio State University Medical Center, Columbus, Ohio
| | - David R Nunley
- Division of Pulmonology, Department of Medicine, The Ohio State University Medical Center, Columbus, Ohio
| | - Ginny Bumgardner
- Division of Transplant Surgery, Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio
| | - Nahush A Mokadam
- Divison of Cardiac Surgery, Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio
| | - Bryan A Whitson
- Divison of Cardiac Surgery, Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio
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Abdellatif AA, Mogawer MS, El- Shazli M, El-Karaksy H, Salah A, Abdel-Maqsod A, El-Amir M, Said M, Zayed N, Hosny K, Eldeen HG, Osman AMA, Mansour DA, Nabil A, Abdel-Ghani A, Mogahed EA, Yasin NA. Resuming post living donor liver transplantation in the COVID-19 pandemic: real-life experience, single-center experience. EGYPTIAN LIVER JOURNAL 2021; 11:92. [PMID: 34956680 PMCID: PMC8686346 DOI: 10.1186/s43066-021-00153-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/07/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Solid organ transplantation (SOT) service has been disrupted during the current coronavirus disease 2019 (COVID-19) pandemic, which deferred the service in most centers worldwide. As the pandemic persists, there will be an urgency to identify the best and safest practices for resuming activities as areas re-open. Resuming activity is a difficult issue, in particular, the decision of reopening after a period of slowing down or complete cessation of activities. OBJECTIVES To share our experience in resuming living donor liver transplantation (LDLT) in the context of the COVID-19 pandemic in the Liver Transplantation Unit of El-Manial Specialized Hospital, Cairo University, Egypt, and to review the obstacles that we have faced. MATERIAL AND METHODS This study is a single-center study. We resumed LDLT by the 26th of August 2020 after a period of closure from the 1st of March 2020. We have taken a lot of steps in order to prevent COVID-19 transmission among transplant patients and healthcare workers (HCWs). RESULTS In our study, we reported three LDLT recipients, once resuming the transplantation till now. All our recipients and donors tested negative for SARS-CoV-2 by nasopharyngeal RT-PCR a day before the transplantation. Unfortunately, one of them developed COVID-19 infection. We managed rapidly to isolate him in a single room, restricting one team of HCWs to deal with him with strict personal protective measures. Finally, the patient improved and was discharged in a good condition. The second patient ran a smooth course apart from FK neurotoxicity which improved with proper management. The third patient experienced a sharp rise in bilirubin and transaminases on day 14 that was attributed to drug toxicity vs. rejection and managed by discontinuing the offending drugs and pulse steroids. In addition, one of our head nurses tested positive for SARS-CoV-2 that was manageable with self-isolation. CONCLUSION Careful patient, donor, personnel screening is mandatory. Adequate supply of personal protective equipments, effective infection control policies, and appropriate administrative modifications are needed for a safe return of LDLT practice.
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Affiliation(s)
- Abeer Awad Abdellatif
- Hepatogastroenterology, Liver Transplantation Unit, Internal Medicine Department, Kasr Al-Aini Hospitals, Cairo University, Kasr Al-Aini Street, Cairo, PO: 11451 Egypt
| | - Mohamad Sherif Mogawer
- Hepatogastroenterology, Liver Transplantation Unit, Internal Medicine Department, Kasr Al-Aini Hospitals, Cairo University, Kasr Al-Aini Street, Cairo, PO: 11451 Egypt
| | - Mostafa El- Shazli
- Department of General Surgery, Liver Transplantation Unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hanaa El-Karaksy
- Pediatrics Department, Liver Transplantation Unit, Cairo University, Cairo, Egypt
| | - Ayman Salah
- Department of General Surgery, Liver Transplantation Unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amany Abdel-Maqsod
- Hepatogastroenterology, Liver Transplantation Unit, Internal Medicine Department, Kasr Al-Aini Hospitals, Cairo University, Kasr Al-Aini Street, Cairo, PO: 11451 Egypt
| | - Mona El-Amir
- Hepatogastroenterology, Liver Transplantation Unit, Internal Medicine Department, Kasr Al-Aini Hospitals, Cairo University, Kasr Al-Aini Street, Cairo, PO: 11451 Egypt
| | - Mohamed Said
- Endemic Medicine, Hepatogastroenterology, Liver Transplantation Unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Naglaa Zayed
- Endemic Medicine Department, Liver Transplantation unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Karim Hosny
- Pediatrics Department, Liver Transplantation Unit, Cairo University, Cairo, Egypt
| | - Hadeel Gamal Eldeen
- Endemic Hepatology and Gastroenterology, Liver Transplantation Unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman M. A. Osman
- General & HPB Surgery, Department of General Surgery, Unit of Hepatobiliary Surgery, Liver Transplantation Unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa A. Mansour
- Department of General Surgery, Liver Transplantation Unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Nabil
- Department of General Surgery, Liver Transplantation Unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Abdel-Ghani
- Hepatogastroenterology, Liver Transplantation Unit, Internal Medicine Department, Kasr Al-Aini Hospitals, Cairo University, Kasr Al-Aini Street, Cairo, PO: 11451 Egypt
| | - Engy A. Mogahed
- Pediatrics Department, Liver Transplantation Unit, Cairo University, Cairo, Egypt
| | - Noha A. Yasin
- Pediatrics Department, Liver Transplantation Unit, Cairo University, Cairo, Egypt
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Millán DAC, Fajardo-Cediel W, Tobar-Roa V, García-Perdomo HA, Autrán-Gómez AM. Strategies to Mitigate the Impact of COVID 19 Pandemic on Organ Donation and Kidney Transplantation in Latin America. Curr Urol Rep 2021; 22:59. [PMID: 34913144 PMCID: PMC8724642 DOI: 10.1007/s11934-021-01076-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW COVID-19 pandemics have severely affected Latin America. It has resulted in SARS-CoV-2-associated clinical adverse outcomes, but also in social and economic deterioration. Consequently, it generated a significant negative impact on organ donation and kidney transplantation (KTx) activity in our region, leading to a negative impact on these patients' survival and quality of life. For this reason, this article aimed to describe applicable logistics, organizational and clinical strategies to mitigate the effect of the COVID-19 pandemic on kidney donation and transplantation in our region. RECENT FINDINGS Absenteeism to hemodialysis sessions in patients with end-stage renal disease has been described in up to 54% in Latin America. Not surprisingly, there was a reduction in organ donation and transplants between 21 and 59%. Also, there is a higher incidence of COVID-19 positive tests in the waiting list population than KTx recipients (9.9%). However, there was a higher mortality rate in KTx recipients than the waiting list population (32%). Additionally, 59% of living donor kidney transplant programs suspended the evaluation of new donors due to the COVID-19 pandemic. Throughout this manuscript, we summarize some practical tips to resume organ donation and KTx during pandemics in Latin America, such as selecting healthy donors and recipients, universal SARS-CoV-2 screening, implementing COVID-19 accessible pathways, and telehealth as a standard, and postpone all non-urgent visits.
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Affiliation(s)
- David Andrés Castañeda Millán
- Department of Surgery, Urology Unit, Hospital Universitario Nacional de Colombia, Universidad Nacional de Colombia, Bogotá, Colombia.
| | | | - Verónica Tobar-Roa
- Urology Department and Kidney Transplant Unit, Clínica FOSCAL, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | | | - Ana María Autrán-Gómez
- Oficina de Investigación Confederación Americana de Urologia (CAU), Buenos Aires, Argentina
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11
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Loinaz-Segurola C, Marcacuzco-Quinto A, Fernández-Ruiz M. Coronavirus disease 2019 in liver transplant patients: Clinical and therapeutic aspects. World J Hepatol 2021; 13:1299-1315. [PMID: 34786167 PMCID: PMC8568575 DOI: 10.4254/wjh.v13.i10.1299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/17/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted liver transplant (LT) activity across the world, with notable decreases in the number of donations and procedures in most Western countries, in particular throughout the first wave. The cumulative incidence of COVID-19 in LT recipients (with estimates ranging from 0.34% to 1.56%) appears to be at least comparable to that observed for the general population. Clinical and radiological features at presentation are also similar to non-transplant patients. The risk of death among LT recipients requiring hospital admission is high (from 12% to 19%), although some authors have suggested that overall mortality may be actually lower compared to the general non-transplant population. It is likely that these poor outcomes may be mainly influenced by the older age and higher comorbidity burden of LT recipients, rather than by the transplant status itself. In fact, it has been hypothesized that post-transplant immunosuppression would exert a protective role, with special focus on tacrolimus-containing regimens. There is scarce evidence to guide the optimal management of post-transplant COVID-19 and the use of antiviral or immunomodulatory therapies, although both clinical practice and guidelines support the dose reduction or withdrawal of anti-proliferative agents such as mofetil mycophenolate. Preliminary reports suggest that the antibody response to messenger RNA vaccines is significantly impaired as compared to non-immunocompromised individuals, in line with other transplant populations. Finally, it is foreseeable that the future will be conditioned by the emerging variants of severe acute respiratory syndrome coronavirus 2 with increased transmissibility among LT recipients.
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Affiliation(s)
- Carmelo Loinaz-Segurola
- HBP and Transplant Surgery Unit. Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid 28041, Spain.
| | - Alberto Marcacuzco-Quinto
- HBP and Transplant Surgery Unit. Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid 28041, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid 28041, Spain
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12
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Kidney Transplantation during the SARS-CoV-2 Pandemic in Israel: Experience from a Large-Volume Center. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2040041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has affected tens of millions of people globally since it was declared a pandemic by the World Health Organization on 11 March 2020. Since its outbreak in December 2019, the ongoing coronavirus COVID-19 pandemic has led to global social, economic and healthcare crises affecting millions of people and causing the death of hundreds of thousands of people worldwide. As with other fields of healthcare, the pandemic with its heavy workload imposed on hospital services and personnel significantly affected solid organ transplantation. Concerns for potential exposure to the virus and its related severe acute respiratory syndrome coronavirus type 2 (SARS-CoV2) have profoundly altered the process of organ donation and recovery, acceptance of organ offers, management of potential recipients and living donors, and above all transplanted and immunosuppressed patients. All those issues required prompt implementation of new practice measures and guidelines as well as continuous adaptations to the fluid and rapidly changing situation. Herein we describe a single transplant center experience with kidney transplantation during the COVID-19 pandemic; we review the national and institutional measures and restrictions undertaken in different phases of the ongoing event as well as the outcomes.
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13
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Li MT, King KL, Husain SA, Schold JD, Mohan S. Deceased Donor Kidneys Utilization and Discard Rates During COVID-19 Pandemic in the United States. Kidney Int Rep 2021; 6:2463-2467. [PMID: 34514207 PMCID: PMC8419126 DOI: 10.1016/j.ekir.2021.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- Miah T Li
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Columbia University Renal Epidemiology Group, New York, New York, USA
| | - Kristen L King
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Columbia University Renal Epidemiology Group, New York, New York, USA
| | - S Ali Husain
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Columbia University Renal Epidemiology Group, New York, New York, USA
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Columbia University Renal Epidemiology Group, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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14
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Doby BL, Hanner K, Johnson S, Purnell TS, Shah MB, Lynch RJ. Results of a data-driven performance improvement initiative in organ donation. Am J Transplant 2021; 21:2555-2562. [PMID: 33314706 DOI: 10.1111/ajt.16442] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/23/2020] [Accepted: 12/07/2020] [Indexed: 01/25/2023]
Abstract
New metrics for organ procurement organization (OPO) performance utilize National Center for Health Statistics data to measure cause, age, and location consistent (CALC) deaths. We used this denominator to identify opportunities for improved donor conversion at one OPO, Indiana Donor Network (INOP). We sought to determine whether such analyses are immediately actionable for quality improvement (QI) initiatives directed at increased donor conversion. CALC-based assessment of INOP's performance revealed an opportunity to improve conversion of older donors. Following the QI initiative, INOP donor yield rose by 44%, while organs transplanted rose by 29%. These changes tolerated temporary disruption around the COVID-19 pandemic. Improved donor yield was primarily seen in older groups identified by CALC-based methods. Process changes in resource allocation and monitoring were associated with a 57% increase in the number of potential donors approached in the QI period and a subsequent rise in the number of potential donor referrals, suggesting positive feedback at area hospitals. Post-intervention, INOP's projected donation performance rose from 51st to 18th among all OPOs. OPOs can use CALC death data to accurately assess donor conversion by categories including age and race/ethnicity. These data can be used in real time to inform OPO-level processes to maximize donor recovery.
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Affiliation(s)
- Brianna L Doby
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Tanjala S Purnell
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Malay B Shah
- Department of Surgery, Division of Abdominal Transplant Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Raymond J Lynch
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia
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15
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Bentata Y. Organ Shortage: Major or Minor Impact of the COVID-19 Pandemic? EXP CLIN TRANSPLANT 2021; 19:624-626. [PMID: 33605197 DOI: 10.6002/ect.2020.0371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Yassamine Bentata
- From the Nephrology Dialysis and Kidney Transplantation Unit, University Hospital Mohammed VI, University Mohammed First.,the Laboratory of Epidemiology, Clinical Research and Public Health, Medical School, University Mohammed First, Oujda, Morocco
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16
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Neidlinger NA, Smith JA, D'Alessandro AM, Roe D, Taber TE, Pereira MR, Friedman AL. Organ recovery from deceased donors with prior COVID-19: A case series. Transpl Infect Dis 2020; 23:e13503. [PMID: 33174324 PMCID: PMC8244092 DOI: 10.1111/tid.13503] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 12/12/2022]
Abstract
Although guidance documents have been published regarding organ donation from individuals with a prior history of COVID‐19 infection, no data exist regarding successful recovery and transplantation from deceased donors with a history of or positive testing suggesting a prior SARS‐CoV‐2 infection. Here, we report a case series of six deceased donors with a history of COVID‐19 from whom 13 organs were recovered and transplanted through several of the nation's organ procurement organizations (OPOs). In addition, at least two potential donors were authorized for donation but with no organs were successfully allocated and did not proceed to recovery. No transmission of SARS‐CoV‐2 was reported from the six donors to recipients, procurement teams, or hospital personnel. Although more studies are needed, organ donation from deceased donors who have recovered from COVID‐19 should be considered.
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Affiliation(s)
| | - Jeannina A Smith
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | | | - David Roe
- Indiana Donor Network, Indianapolis, IN, USA
| | - Tim E Taber
- Indiana Donor Network, Indianapolis, IN, USA
| | - Marcus R Pereira
- Department of Medicine, Columbia University College of Physicians, New York, NY, USA
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17
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Valdes E, Agarwal S, Carroll E, Kvernland A, Bondi S, Snyder T, Kwon P, Frontera J, Gurin L, Czeisler B, Lewis A. Special considerations in the assessment of catastrophic brain injury and determination of brain death in patients with SARS-CoV-2. J Neurol Sci 2020; 417:117087. [PMID: 32798855 PMCID: PMC7414304 DOI: 10.1016/j.jns.2020.117087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/14/2020] [Accepted: 08/06/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The coronavirus disease 2019 (Covid-19) pandemic has led to challenges in provision of care, clinical assessment and communication with families. The unique considerations associated with evaluation of catastrophic brain injury and death by neurologic criteria in patients with Covid-19 infection have not been examined. METHODS We describe the evaluation of six patients hospitalized at a health network in New York City in April 2020 who had Covid-19, were comatose and had absent brainstem reflexes. RESULTS Four males and two females with a median age of 58.5 (IQR 47-68) were evaluated for catastrophic brain injury due to stroke and/or global anoxic injury at a median of 14 days (IQR 13-18) after admission for acute respiratory failure due to Covid-19. All patients had hypotension requiring vasopressors and had been treated with sedative/narcotic drips for ventilator dyssynchrony. Among these patients, 5 had received paralytics. Apnea testing was performed for 1 patient due to the decision to withdraw treatment (n = 2), concern for inability to tolerate testing (n = 2) and observation of spontaneous respirations (n = 1). The apnea test was aborted due to hypoxia and hypotension. After ancillary testing, death was declared in three patients based on neurologic criteria and in three patients based on cardiopulmonary criteria (after withdrawal of support (n = 2) or cardiopulmonary arrest (n = 1)). A family member was able to visit 5/6 patients prior to cardiopulmonary arrest/discontinuation of organ support. CONCLUSION It is feasible to evaluate patients with catastrophic brain injury and declare brain death despite the Covid-19 pandemic, but this requires unique considerations.
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Affiliation(s)
- Eduard Valdes
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States of America.
| | - Shashank Agarwal
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States of America
| | - Elizabeth Carroll
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States of America
| | - Alexandra Kvernland
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States of America
| | - Steven Bondi
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States of America
| | - Thomas Snyder
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States of America
| | - Patrick Kwon
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States of America
| | - Jennifer Frontera
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States of America; NYU Langone Medical Center, Department of Neurosurgery, New York, NY 10016, United States of America
| | - Lindsey Gurin
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States of America; NYU Langone Medical Center, Department of Psychiatry, New York, NY 10016, United States of America; NYU Langone Medical Center, Department of Rehabilitation Medicine, New York, NY 10016, United States of America
| | - Barry Czeisler
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States of America; NYU Langone Medical Center, Department of Neurosurgery, New York, NY 10016, United States of America
| | - Ariane Lewis
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States of America; NYU Langone Medical Center, Department of Neurosurgery, New York, NY 10016, United States of America
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