Perspectives on donor‐derived infections from Germany

Transplant Infectious Disease, Journal Year: 2024, Volume and Issue: unknown

Published: Sept. 23, 2024

Often, organ transplantation is the only option to improve life expectancy and quality of patients with terminal failure. Despite improved donor assessment, a residual risk remains for transmitting infection, tumor, or other disease from recipients. Analysis, reporting, managing donor-derived diseases through vigilance surveillance system (V&S) mandatory in many countries. We report on suspected proven/probable infections (DDI) Germany over period 8 years (2016-2023).

Language: Английский

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Kidney Transplant Practice in Pandemic Times

Clinical Journal of the American Society of Nephrology, Journal Year: 2023, Volume and Issue: 18(7), P. 961 - 964

Published: Jan. 30, 2023

Introduction The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) pandemic affected the entire kidney transplant system, from pretransplant evaluation, waitlist access, donation, organ utilization and transplantation through post-transplant outcomes, often in ways that exacerbated existing inequities.1 Kidney recipients with COVID-19, by underlying comorbidity chronic immunosuppression, have higher morbidity mortality than nontransplant patients COVID-19.2 As vaccines treatment options for COVID-19 became available, outcomes improved overall, but complications remained high recipients.1 Thus, while an end to may be sight general population, will require better prevention regimens. candidates want know "When we get back normal? Who can trust navigate rapidly, changing landscape?" What learned this improve future outcomes? Impact of Pandemic on Transplantation Rates During first phase pandemic, as scarce hospital resources were directed care practice was profoundly disrupted. Deceased donor slowed, limited particular urgency. Living transplantation, considered "elective" surgery many centers, generally halted avoid risk infection living donors recipients.3 Transplant programs made adaptations remain open. When critical unit staff redeployed units, remaining assumed wider responsibilities. Operating room time availability, anesthesia services, intensive (ICU) beds all severely limited. emergency eased center center, these reconstituted. Determining infectious status organs needed. A rebound deceased facilitated when Organ Procurement Network (OPTN) captured reported SARS-CoV-2 testing results. Expanded online patient education use telehealth streamlined evaluation follow-up centers. In contrast recovery 2020 2021 lagged behind levels, disparities Black patients.4 Lessons Learned Decisions continue or curtail during a disaster should evaluated continuously. essential procedure within limits local safety. While delayed times, vigilance is necessary exacerbating access transplantation.4 knowledge treatments evolve such centers continuously communicate nephrologists. Critical must retained, even if temporarily reassigned duties, ensure program success after disaster. Infection Donation Early donation Organizations processes fell dramatically. decline traumatic deaths nationally, dramatic rise ICU admissions opportunities donation. For fewer available potential organs, obtaining consent next-of-kin challenged in-person contact. Inconsistent availability donors5 surgery. Before advent effective antiviral therapy, COVID-19–positive excluded Time-sensitive later informed procurement placement, cases allograft SARS-CoV-2–positive emerged.6 Short-term suggest well-selected SARS-CoV-2–infected safe noninfected donors.7 Emerging experience also demonstrates safety select recovered patients. Rapid development reliable time-sensitive testing, along reporting OPTN, are make acceptance decisions pandemic. future, prompt monitoring, data analysis, help determine novel infections safely used proceed transplant. Experiential Medicine versus Evidence-Based Medicine: Challenges Innovations Immunocompromised every major clinical trial, including vaccines. Without efficacy patients, clinicians extrapolated population COVID-19.1 Access vaccination, medications, procedures varied geography, which led regional variations immunosuppression modification, prophylactic interventions, other treatments. Information sharing collaboration among institutions worldwide increased This unparalleled cooperation helped guide individual evidence scarce. With only short-term observational remdesivir disease, initially contraindicated. More recent reduces without significant nephrotoxicity recipients. Other empiric therapies instituted unhelpful and, sometimes, harmful.1 Although OPTN added cause death, it did not capture patient-level information related vaccinations, treatments, changes immunosuppression. database difficult correlate outcomes. their best draw conclusions, felt confused asked trusted sources information. emergency, extremely valuable. absence randomized controlled trials robust data, questions answered. "lesser quality" surveys national patterns experiential medicine, continuous tracking reporting, generate inform practice. rigorous registries tools rapidly analyze sooner. Health agencies providers provide ongoing authoritative landscape. impact building community invaluable "buy-in" serve, especially times uncertainty. addition, recognize manage lasting mental health consequences providers. Vaccination Prophylactic Interventions emergence played role reducing severity at large, had regarding vaccine efficacy, safety, reactogenicity. Because few immunocompromised participated trials, most gathered came patient-initiated sharing. These influenced our understanding "fully vaccinated," need timing booster immunization, pre-exposure prophylaxis immunosuppressed who adequate immune responses vaccination. Data analysis now shows vaccination associated reduced patients.2 Professional societies strongly recommend before possible8 given new variants, advise vaccinated maintain personal measures minimize exposure. US encourage exhibited heterogeneity mandate policies, citing administrative opposition, legal prohibitions, concern about equity transplants.9 Preventative regimens solid careful application re-evaluation Excluding delays funding drug studies "misses" change future. individuals included therapeutic agents. Policy, Advocacy, Regulatory Changes proactive response requests. Programs allowed apply retroactive waiting modification unable obtain timely required registration. temporary inactivation reasons precautions loss paused some form submission requirements. Centers Medicare & Medicaid Services Tier 3b designation relaxation telemedicine restrictions facilitate reduce possible exposure visits. Scientific Registry Recipients conducted "carve out" performance reports March 13, 2020, June 12, "all hands deck" devoted rather acquisition.10 Regulators, payers, policy makers emergencies, priority focus accessibility adjust requirements accordingly. Reporting waivers roles making more accessible repeated emergencies. Summary adverse risk. therapeutics, so unknown. Survey direct care. pandemics, screening wide early transplantation. Drug include population. Legislators regulators work adapt policies needs caregivers crises.

Language: Английский

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Do Center-specific Factors Impact Utilization of Organs From COVID-positive Donors in the United States?

Transplantation Direct, Journal Year: 2023, Volume and Issue: 9(3), P. e1456 - e1456

Published: Feb. 22, 2023

Utilization of organs from coronavirus disease 2019–positive (COVID+) donors for solid organ transplantation remains variable across various centers in the United States.1 Despite good quality available COVID+ and no known transmission severe acute respiratory syndrome 2 to recipient,1 factors associated with utilization these remain poorly defined. The aim our study was investigate correlation between a transplant center's use donors, its volume, hepatitis C virus–positive (HCV+) organs. Retrospective analysis using Network Organ Sharing database January 2020 March 2022 performed. Adult deceased kidney, liver, heart transplants were included further separated into COVID–nucleic acid amplification test (NAT) positive (COVID+), COVID-NAT negative (COVID–), HCV-NAT (HCV+), (HCV–) groups. estimated annual volume (eVolume) calculated: {12*(total January-2020 March-2022)/27}. Centers eVolume <5 excluded. Linear regression performed evaluate association HCV+ eVolume. A P value <0.05 defined as statistically significant. total 248 that 234 130 131 study. Solid 139 (overall 56%), kidney 121 (51.7%), liver 75 (57.7%), 44 (33.6%). (P < 0.001) seen well (Figure 1; Table S1, SDC, https://links.lww.com/TXD/A508; Figures S1 S2, SDC,https://links.lww.com/TXD/A508). Our results show used donor less likely be low-volume more donors.FIGURE 1.: Correlation COVID-19 UNOS region: (A) all organs, (B) (C) (D) heart. Size bubble indicates transplant. regions are color coded (region 1–11). COVID-19, 2019; HCV, virus; UNOS, Sharing.There is regional center-wide variation extended-criteria including those increased infectious risk such B, concurrent bacterial infections, now COVID-19.1,2 This multifactorial based on waitlist size, shortage, waiting times, availability, center competition, experience team, changes allocation systems, "risk averseness" program.3 Besides factors, increased-risk requires strong, team-oriented, multidisciplinary approach along readily resources pursuit therapeutics diagnostics novel cause. high-volume has been shown improved risk-adjusted outcomes types.4,5 An increase baseline success center, local geographic population-based challenges, often alters risk–benefit pursing an individual may allow "aggressive" accumulate additional regarding higher-risk recipients or otherwise donors. significant highlights existing practices. Further identification leading disparities will help expand pool by decreasing discard rate increasing safe

Language: Английский

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COVID-19 in donation and transplant

Revista Española de Quimioterapia, Journal Year: 2022, Volume and Issue: 35(Suppl3), P. 54 - 62

Published: Oct. 24, 2022

SARS-CoV-2 infection has had a major impact on donation and transplantation. Since the cessation of activity two years ago, international medical community rapidly generated evidence capable sustaining increasing this neccesary activity. This paper analyses epidemiology burden COVID-19 in transplantation, pathogenesis its relationship with graft-mediated transmission, vaccination evolution Spain throughout pandemic, some lessons learned infected donor recipients positive PCR applicability main therapeutic tools recently approved for treatment among transplant recipients.

Language: Английский

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Chronological and Geographical Variations in the Incidence and Acceptance of COVID‐19–Positive Donors and Outcomes Among Abdominal Transplant Patients

Clinical Transplantation, Journal Year: 2024, Volume and Issue: 38(7)

Published: July 1, 2024

Given the importance of understanding COVID-19-positive donor incidence and acceptance, we characterize chronological geographic variations in COVID-19 relative to acceptance.

Language: Английский

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Acceptance of Organs from Deceased Donors With Resolved or Active SARS-CoV-2 Infection: A Survey From the Council of Europe

Transplant International, Journal Year: 2024, Volume and Issue: 37

Published: Nov. 21, 2024

SARS-CoV-2 infection represents a new challenge for solid organ transplantation (SOT) with evolving recommendations. A cross-sectional survey was performed (February-June 2024) to describe practices among Member States of the Council Europe (COE) on use organs from deceased donors resolved or active infection. Overall, 32 out 47 transplant program participated in study. Four (12.5%) countries did not either and 8 (25%) accepted only Donor evaluation included universal screening standard PCR testing respiratory specimens generally (61.4%) within 24 h prior recovery. Further microbiological, immunological radiological investigations varied. Most waitlisted patients receiving donor (94.5%) (61.5%) were preferred have natural, vaccine-induced hybrid immunity. require recipients undergo specific anti-SARS-CoV-2 treatment as pre-exposure (0%), post-exposure prophylaxis (15.4%) modification immunosuppression regimen (24%). This study highlights similarities heterogeneities management positive between COE countries, potential safely expand donors' pool.

Language: Английский

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Recommendations for SARS-CoV-2 testing and organ procurement from deceased donors in the Republic of Korea

Korean Journal of Transplantation, Journal Year: 2023, Volume and Issue: 37(3), P. 145 - 154

Published: Aug. 24, 2023

Si-Ho Kim, Yu Mi Wi, Chisook Moon, Ji-Man Kang, Minhwa Jungok Jong Man Hyeri Seok, Hye Jin Shi, Su Lee, Ji Yeon Jeong, Pyoeng Gyun Choe, Kyungmin Huh, Sang-Oh Sang Il Kim; Transplant Infection Research Committee of the Korean Society Infectious Diseases. J -0001;0:. https://doi.org/10.4285/kjt.23.0034

Language: Английский

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Coronavirus Disease 2019 (COVID-19) in Heart Transplant Recipients and Anti-SARS-CoV-2 Monoclonal Antibodies: Experience, Lessons Learnt, and Future Challenges

Cardiology in Review, Journal Year: 2024, Volume and Issue: unknown

Published: Feb. 8, 2024

Solid organ transplant recipients (SOTRs), including heart (HT) recipients, infected with Coronavirus disease 2019 (COVID-19) are at higher risk of hospitalization, mechanical ventilation, or death when compared general population. Advances in diagnosis and treatment severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have reduced COVID-19-related mortality rates from ~30% the early pandemic to <3% 2022 among HT recipients. We performed a retrospective chart review adult Westchester Medical Center January 1, 2020 December 10, 2022, who received anti-SARS-CoV-2 monoclonal antibodies (mAbs) for mild-to-moderate COVID-19, those tixagevimab/cilgavimab preexposure prophylaxis. Additionally, comprehensive literature involving SOTRs mAbs COVID-19 was conducted. In this largest single-center study population, 42 casirivimab/imdevimab (36%), sotrovimab (31%), bebtelovimab (29%) COVID-19. Among these no infusion-associated adverse effects, progression disease, COVID-19-associated hospitalizations, were noted. Preexposure prophylaxis given 63 dedicated infusion center (40%), inpatient setting (33%), time annual biopsy (27%). No immediate events There 11 breakthrough infections, all mild. Overall, data suggests that receiving need intensive care unit care, death. Use is resource requires programmatic team approach optimal administration minimize any disparities their use.

Language: Английский

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Single-center Outcomes After Liver Transplantation With SARS-CoV-2–Positive Donors: An Argument for Increased Utilization

Transplantation Direct, Journal Year: 2024, Volume and Issue: 10(4), P. e1590 - e1590

Published: March 7, 2024

Background. The COVID-19 pandemic has led to an increase in SARS-CoV-2–test positive potential organ donors. benefits of life-saving liver transplantation (LT) must be balanced against the risk donor-derived viral transmission. Although emerging evidence suggests that use COVID-19–positive donor organs may safe, granular series thoroughly evaluating safety are still needed. Results 29 consecutive LTs from donors at a single center presented here. Methods. A retrospective cohort study LT recipients between April 2020 and December 2022 was conducted. Differences (n = total; 25 index, 4 redo) COVID-19–negative 472 454 18 deceased grafts were compared. Results. significantly younger ( P 0.04) had lower kidney profile indices than Recipients older but otherwise similar negative Donor SARS-CoV-2 infection status not associated with overall survival (hazard ratio, 1.11; 95% confidence interval, 0.24-5.04; 0.89). There 3 deaths among No death seemed virally mediated because there no qualitative association peri-LT antispike antibody titers, post-LT prophylaxis, or variants. Conclusions. utilization decreased recipients. suggestion transmission recipient. results this large single-center suggest used safely expand pool.

Language: Английский

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The Effects of COVID-19 in Kidney Transplantation: Evidence From Tissue Pathology

Transplantation, Journal Year: 2024, Volume and Issue: unknown

Published: July 18, 2024

The biological effects of SARS-CoV-2 infection in transplanted kidneys are uncertain with little pathological information.

Language: Английский

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