17 Mar 2020: Trends in Donation and Transplant Amid Coronavirus

Key is to know things in transplant and donation are evolving as quickly as they are in every other aspect of life right now.

  • UNOS has created a link in DonorNet to “Report COVID-19 Related Issues Impacting Donation and Transplantation.”  It appears to essentially be a questionnaire for programs in order for the OPTN and DHHS to determine needs during this time.
  • OPO’s
    • No policies have been implemented around testing of donors.
    • Private companies have been identified that can run COVID-19 testing in a 12-24 hour timeframe for OPO’s.  However, this remains at the discretion of the OPO and there does not seem to be consistency with which donors will be tested.
    • OPO’s are beginning to screen accepting centers recovery teams for potential exposure to coronavirus. At this point it seems this is a questionnaire type screening.  There are OPO’s now restricting physicians from Level 3 “hot zones” from flying in for recovery of organs. If they accept organs, the local OPO is willing to provide recovery surgeries.
  • Transplant Centers
    • More centers are restricting acceptance of organs to only donors who have been tested for COVID-19, regardless of exposure.  This seems to be a day to day decision.
    • Although data is limited, and only discussion text has been released so far. Dr D’Antiga of Italy shared a statement regarding “Coronavirus pandemic and immunocompromised liver patients.”  It is a reassuring article that suggest immunosuppressed patients may actually have less compromise with coronavirus as it seems it is not the virus itself that damages the lungs, but the body’s immune response to the virus.  By having a suppressed immune system response the lungs are impacted less. (text below)

 

CenterSpan Listserve released 3/16/20
—-Coronavirus pandemic and immunosuppressed liver patients.

Lorenzo D’Antiga, MD Pediatric Hepatology, Gastroenterology and Transplantation Hospital Papa Giovanni XXIII, Bergamo Italy 

 

Following the outbreak in China, the Lombardy region of Italy has become one of the areas of highest incidence of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) new cases. In Lombardy approximately a thousand new infected subjects are reported every day. After the outbreak grew to a pandemic, many liver centres worldwide raised the concern that immunocompromised patients may be at high risk of developing a severe respiratory disease called COVID-19.The Hospital Papa Giovanni XXIII in Bergamo is located in the “red zone” of the Italian outbreak, and hosts the largest pediatric hepatology and liver transplantation centre in Italy. We therefore considered important to review available data, and report our preliminary experience with these patients, to share hints on possible challenges presented by immunosuppressed patients during this outbreak.As a preliminary point, it is important to highlight that, unlike common viral agents (such as Adenovirus, Rhinovirus, Norovirus, Influenza, Respiratory Syncytial Virus), Coronaviruses have not shown to cause a more severe disease in immunosuppressed patients. For this family of viruses the host innate immune response appears the main driver of lung tissue damage during infection. These findings suggest that, in this setting, an immunocompromised host may potentially be protected by a weaker immune response against the virus. 

 

Secondly, reviewing the mortality and morbidity reports published on Coronaviruses outbreaks such as Severe Acute Respiratory Syndrome (SARS) emerged in 2002, Middle East Respiratory Syndrome (MERS, still ongoing) and more recently COVID-19, no mention is found on immunosuppression as a risk factor for severe disease or mortality. No fatality was reported in patients undergoing transplantation, chemotherapy or other immunosuppressive treatments, at any age.  Common risk factors for poor outcome include advanced age, male sex and presence of comorbidities (obesity, diabetes, heart disease, lung disease, kidney disease).Our preliminary experience, in agreement with recent data from China, shows that, among patients in the follow-up for cirrhosis, transplantation, autoimmune liver disease, chemotherapy for hepatoblastoma, none developed a clinical pulmonary disease, despite some tested positive for SARS-CoV-2.

 

In conclusion, the experience made on Coronavirus outbreaks suggests that immunosuppressed patients are not at increased risk of severe to the general population, both children and adults. Although children do not develop Coronavirus pneumonia, they can carry the virus and spread the infection. With appropriate precautions, aimed especially to avoid virus spreading, all efforts should be made to continue the normal transplant activity in pediatric and adult liver services. Despite the resource consumption of SARS-CoV-19 epidemic, it is important to circumvent the risk that this pandemic indirectly increases mortality and morbidity of commonly treatable diseases.

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