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de Vries APJ, Alwayn IPJ, Hoek RAS, van den Berg AP, Ultee FCW, Vogelaar SM, Haase-Kromwijk BJJM, Heemskerk MBA, Hemke AC, Nijboer WN, Schaefer BS, Kuiper MA, de Jonge J, van der Kaaij NP, Reinders MEJ. Immediate impact of COVID-19 on transplant activity in the Netherlands. Transpl Immunol 2020; 61:101304. [PMID: 32371150 PMCID: PMC7194049 DOI: 10.1016/j.trim.2020.101304] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 01/08/2023]
Abstract
The rapid emergence of the COVID-19 pandemic is unprecedented and poses an unparalleled obstacle in the sixty-five year history of organ transplantation. Worldwide, the delivery of transplant care is severely challenged by matters concerning - but not limited to - organ procurement, risk of SARS-CoV-2 transmission, screening strategies of donors and recipients, decisions to postpone or proceed with transplantation, the attributable risk of immunosuppression for COVID-19 and entrenched health care resources and capacity. The transplant community is faced with choosing a lesser of two evils: initiating immunosuppression and potentially accepting detrimental outcome when transplant recipients develop COVID-19 versus postponing transplantation and accepting associated waitlist mortality. Notably, prioritization of health care services for COVID-19 care raises concerns about allocation of resources to deliver care for transplant patients who might otherwise have excellent 1-year and 10-year survival rates. Children and young adults with end-stage organ disease in particular seem more disadvantaged by withholding transplantation because of capacity issues than from medical consequences of SARS-CoV-2. This report details the nationwide response of the Dutch transplant community to these issues and the immediate consequences for transplant activity. Worrisome, there was a significant decrease in organ donation numbers affecting all organ transplant services. In addition, there was a detrimental effect on transplantation numbers in children with end-organ failure. Ongoing efforts focus on mitigation of not only primary but also secondary harm of the pandemic and to find right definitions and momentum to restore the transplant programs.
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Affiliation(s)
- A P J de Vries
- Department of Internal Medicine, Division of Nephrology and Transplant Center, Leiden University Medical Center, Leiden, the Netherlands
| | - I P J Alwayn
- Department of Surgery, Division of Transplant Surgery and Transplant Center, Leiden University Medical Center, Leiden, the Netherlands
| | - R A S Hoek
- Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - A P van den Berg
- Department of Gastroenterology and Hepatology, University Hospital Groningen, Groningen, the Netherlands
| | - F C W Ultee
- Department of Nephrology and surgery/transplant coordination, Academic Medical Center, Amsterdam, the Netherlands
| | - S M Vogelaar
- Eurotransplant International, Leiden, the Netherlands
| | | | - M B A Heemskerk
- Dutch Transplant Foundation (DTF/NTS), Leiden, the Netherlands
| | - A C Hemke
- Dutch Transplant Foundation (DTF/NTS), Leiden, the Netherlands
| | - W N Nijboer
- Department of Surgery, Division of Transplant Surgery and Transplant Center, Leiden University Medical Center, Leiden, the Netherlands
| | - B S Schaefer
- Dutch Transplant Foundation (DTF/NTS), Leiden, the Netherlands
| | - M A Kuiper
- Dutch Transplant Foundation (DTF/NTS), Leiden, the Netherlands.; Medical Center Leeuwarden, Department of Intensive care, Leeuwarden, the Netherlands
| | - J de Jonge
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Dutch Transplant Society (DTS/NTV), the Netherlands
| | - N P van der Kaaij
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Dutch Transplant Society (DTS/NTV), the Netherlands
| | - M E J Reinders
- Department of Internal Medicine, Division of Nephrology and Transplant Center, Leiden University Medical Center, Leiden, the Netherlands; Dutch Transplant Society (DTS/NTV), the Netherlands.
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Peters-Sengers H, Houtzager JHE, Heemskerk MBA, Idu MM, Minnee RC, Klaasen RW, Joor SE, Hagenaars JAM, Rebers PM, van der Heide JJH, Roodnat JI, Bemelman FJ. DCD donor hemodynamics as predictor of outcome after kidney transplantation. Am J Transplant 2018; 18:1966-1976. [PMID: 29380523 DOI: 10.1111/ajt.14676] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/29/2017] [Accepted: 01/19/2018] [Indexed: 01/25/2023]
Abstract
Insufficient hemodynamics during agonal phase-ie, the period between withdrawal of life-sustaining treatment and circulatory arrest-in Maastricht category III circulatory-death donors (DCD) potentially exacerbate ischemia/reperfusion injury. We included 409 Dutch adult recipients of DCD donor kidneys transplanted between 2006 and 2014. Peripheral oxygen saturation (SpO2-with pulse oximetry at the fingertip) and systolic blood pressure (SBP-with arterial catheter) were measured during agonal phase, and were dichotomized into minutes of SpO2 > 60% or SpO2 < 60%, and minutes of SBP > 80 mmHg or SBP < 80 mmHg. Outcome measures were and primary non-function (PNF), delayed graft function (DGF), and three-year graft survival. Primary non-function (PNF) rate was 6.6%, delayed graft function (DGF) rate was 67%, and graft survival at three years was 76%. Longer periods of agonal phase (median 16 min [IQR 11-23]) contributed significantly to an increased risk of DGF (P = .012), but not to PNF (P = .071) and graft failure (P = .528). Multiple logistic regression analysis showed that an increase from 7 to 20 minutes in period of SBP < 80 mmHg was associated with 2.19 times the odds (95% CI 1.08-4.46, P = .030) for DGF. In conclusion, duration of agonal phase is associated with early transplant outcome. SBP < 80 mmHg during agonal phase shows a better discrimination for transplant outcome than SpO2 < 60% does.
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Affiliation(s)
- H Peters-Sengers
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center, University of Amsterdam, the Netherlands
| | - J H E Houtzager
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | - M M Idu
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - R C Minnee
- Department of Surgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - R W Klaasen
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - S E Joor
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - J A M Hagenaars
- Department of Surgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - P M Rebers
- Department of Surgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - J J Homan van der Heide
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - J I Roodnat
- Department of Nephrology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - F J Bemelman
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Haase-Kromwijk BJJM, Heemskerk MBA, Weimar W, Berger SP, Hoitsma AJ. [Waiting list registration for kidney transplants must improve]. Ned Tijdschr Geneeskd 2017; 161:D812. [PMID: 28378695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate how the composition of the waiting list for postmortem kidney transplant has developed, and whether the waiting list reflects actual demand. DESIGN Retrospective research and cohort study. METHOD We used data from the period 2000-2014 from the Dutch Transplant Foundation, 'RENINE' and Eurotransplant. This concerned data on postmortem kidney donation, live donor transplants, the waiting list and kidney transplantation. RESULTS The postmortem kidney transplant waiting list included transplantable (T) and non-transplantable (NT) patients. The number of T-patients declined from 1271 in 2000 to 650 in 2014, and the median waiting time between the start of dialysis and postmortem kidney transplant decreased from 4.1 years in 2006 to 3.1 years in 2014. The total number of patients on the waiting list, however, increased from 2263 in 2000 to 2560 in 2014 and in the same period the number of new patient registrations increased from 772 to 1212. In about 80% of the NT-patients the reason for their NT status was not registered. A cohort analysis showed that NT-patients have a 2-times lower chance of a postmortem kidney transplant and a 2-times higher chance of leaving the waiting list without transplantation or of live-donor transplantation. CONCLUSION The demand for donor kidneys remains high. The increased number of transplants resulted in a declining waiting list for T-patients while the total waiting list is getting longer. Waiting list registration and maintenance need to be improved, to give better insight into the real demand.
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Heemskerk MBA, Cornelissen JJ, Roelen DL, van Rood JJ, Claas FHJ, Doxiadis IIN, Oudshoorn M. Highly diverged MHC class I mismatches are acceptable for haematopoietic stem cell transplantation. Bone Marrow Transplant 2007; 40:193-200. [PMID: 17529995 DOI: 10.1038/sj.bmt.1705721] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A fully major histocompatilbility complex (MHC) matched donor is not available for the majority of patients in need of a haematopoietic stem cell transplantation (SCT), which illustrates the need for a tool to define acceptable MHC disparities. Previously, we noticed that a variety of single MHC class I mismatched allogeneic donor-recipient pairs did not elicit an allogeneic cytotoxic-lymphocyte (CTL) response in vitro if the MHC amino-acid sequences had five or more differences in the alpha-helices plus five or more differences in the beta-sheet (> or =5alpha5beta) (7). To address the clinical relevance of this observation, we analysed CTL precursor (CTLp) assay outcome and SCT outcome in 53 Dutch recipients of a single MHC class I mismatched graft from an unrelated donor. Overall patient survival was 44% after 4 years. In multivariate analysis, recipients of a > or =5alpha5beta mismatched graft with negative CTLp frequencies in vitro before transplantation demonstrated superior survival: survival at 4 years was 80% as compared to 47% in recipients of other mismatched grafts with negative CTLp frequencies (hazard ratio=0.131; 95% CI=(0.03-0.61); P=0.009). This option of acceptable mismatches may enlarge the pool of potentially acceptable stem cell donors.
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Affiliation(s)
- M B A Heemskerk
- Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.
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Oudshoorn M, van Walraven SM, Bakker JNA, Lie JLWT, V D Zanden HGM, Heemskerk MBA, Claas FHJ. Hematopoietic Stem Cell Donor Selection: the Europdonor Experience. Hum Immunol 2006; 67:405-12. [PMID: 16728261 DOI: 10.1016/j.humimm.2006.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Indexed: 11/22/2022]
Abstract
International collaboration is essential for the optimal selection of unrelated hematopoietic stem cell donors. This review focuses on the benefit of a joint worldwide donor file called Bone Marrow Donors Worldwide and the experience of the Europdonor Foundation in selecting strategies to identify the best human leukocyte antigen-matched donor in the shortest time.
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Affiliation(s)
- M Oudshoorn
- Europdonor Foundation, Leiden, the Netherlands
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Heemskerk MBA, Doxiadis IIN, Roelen DL, Claas FHJ, Oudshoorn M. The HistoCheck algorithm does not predict T-cell alloreactivity in vitro. Bone Marrow Transplant 2005; 36:927-8. [PMID: 16151420 DOI: 10.1038/sj.bmt.1705154] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Heemskerk MBA, van Walraven SM, Cornelissen JJ, Barge RMY, Bredius RGM, Egeler RM, Tj Lie JLW, Révész T, Sintnicolaas K, Wulffraat NM, Donker AE, Hoogerbrugge PM, van Rood JJ, Claas FHJ, Oudshoorn M. How to improve the search for an unrelated haematopoietic stem cell donor. Faster is better than more! Bone Marrow Transplant 2005; 35:645-52. [PMID: 15723086 DOI: 10.1038/sj.bmt.1704865] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Many patients do not reach haematopoietic stem cell transplantation. Shortage of unrelated donors (UDs) is still seen as the main cause. However, with a worldwide UD pool containing more than 8 million donors, it is possible that other impediments are becoming more important. We analysed 549 UD searches for Dutch patients, performed between 1987 and 2000, in order to find the reasons for failure or success to reach transplantation. Between 1996 and 2000, 59% of the patients of Northwest European origin received a graft from an UD with a median time span of 4.4 months from the start of the search. In all, 11% of the patients lacked a compatible donor, while 30% became medically unfit for transplantation. This is in contrast to the patients of non-Northwest European origin for whom UD shortage is still the most important impediment; only 32% were transplanted while 50% lacked a compatible donor. We conclude that the shortage of donors is no longer the biggest constraint in unrelated stem cell transplantation for patients of Northwest European origin. It may be more effective to optimize the chance on transplantation by making the search process more efficient.
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van Walraven SM, Heemskerk MBA, Lie JLWT, Barge RMY, Cornelissen JJ, Egeler RM, Verdonck LF, Wulffraat N, Oudshoorn M. The importance of identifying a back-up donor for unrelated stem cell transplantation. Bone Marrow Transplant 2005; 35:437-40. [PMID: 15640816 DOI: 10.1038/sj.bmt.1704812] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The importance of identifying a back-up donor, once a primary suitable unrelated stem cell donor has been found, is often underestimated. Transplant centres erroneously count on the unrelated volunteer donors to be willing, available and medically fit for actual donation. According to our data, which includes 502 unrelated donor work-up procedures performed for 425 Dutch patients between 1987 and 2002, one of 11 work-ups ended in the primary requested donor failing to donate. Of all donor-related cancellations (N=46), 78% of the procedures were deferred due to medical reasons and 22% due to nonmedical reasons. Most of the donors deferred for medical reasons were female (P=0.005). In 50% of the cases for which a back-up donor was already identified, the patients were transplanted with a delay of less then 2 weeks; when no back-up donor was available, the median delay increased to 18 weeks. We strongly encourage implementing a search for at least one back-up donor in the primary search. Identifying a back-up donor can save precious time and complicated logistic rescheduling.
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