COVID-19

COVID and challenges in transplantation

  • 1.  COVID and challenges in transplantation

    Posted 03-12-2020 14:30

    Dear Transplant Providers,

    What actions/precautions are transplant centers taking to protect transplant patients from COVID19? How many centers are masking all providers for all visits? cancelling routine procedures and converting to telemedicine for routine visits? transplant only waiting rooms?

    Is your center testing donors for COVID 19?

    Best, Sophia Airhart

    ------------------------------
    Sophia Airhart MD, FACC
    Assistant Professor of Medicine
    Faculty, Pulmonary Hypertension Program at Banner University Medical Center
    Faculty, Division of Cardiology, Advanced Heart Failure and Transplantation
    University of Arizona Medical Center – Tucson
    ------------------------------


  • 2.  RE: COVID and challenges in transplantation

    Posted 03-13-2020 00:58
    Right now this third world country cannot even test live patients, so how would we be able to test donors? Read below and get a reality check. 

    Sick People Across the U.S. Say They Are Being Denied the Coronavirus Test
    https://www.nytimes.com/2020/03/12/us/coronavirus-testing-challenges.html?referringSource=articleShare

    Sent from my iPhone





  • 3.  RE: COVID and challenges in transplantation

    Posted 03-13-2020 14:01
    Has anyone been testing donors in Europe or elsewhere where testing is widely available?

    thank you

    ------------------------------
    Reda Girgis
    Grand Rapids MI
    (616) 391-6903
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  • 4.  RE: COVID and challenges in transplantation

    Posted 03-14-2020 03:41
    ​Dear Reda Girgis

    We recently had a donor who was tested for COVID-19 before accepting organs for transplant.
    This is probably going to be standard in the near future if we shall continue to do transplants  under the epidemic.




    ------------------------------
    Michael Perch
    København Ø
    004535459702
    ------------------------------



  • 5.  RE: COVID and challenges in transplantation

    Posted 03-14-2020 03:42
    We test donors - not only NP swabs but also bronchoalveolar lavage since false neg NP is not rare - history of contacts and geographical considerations are useful - abnormal lung CT is highly suspicious. And of course we are not sure we are doing "the right thing" - risk-benefit profile of Tx in current conditions is evaluated day by day /hour by hour...​​

    ------------------------------
    Maria Frigerio
    Milano
    0264447791
    ------------------------------



  • 6.  RE: COVID and challenges in transplantation

    Posted 03-14-2020 04:28
    Edited by Christian Benden 03-14-2020 04:31
    Dear All,

    Here in Switzerland, PCR diagnostics must have been carried out now on all potential donors to exclude the possibility of COVID-19 infection and recorded. The test result must be available before organs can be transplanted. If PCR test is positive, the transplant is not executed.

    Kind regards,

    Christian Benden

    ------------------------------
    Prof Christian Benden MD FCCP
    Senior Medical Consultant

    Swisstransplant
    CH-3011 Bern
    Switzerland
    E-mail: christian.benden@swisstransplant.org
    ------------------------------



  • 7.  RE: COVID and challenges in transplantation

    Posted 03-14-2020 05:12
    Hi everyone,
    please keep sending your countries standards
    in Poland we have an epidemiological questionnaire and then testing is done if there are risk factors - I COMPLETELY disagree we have on average 2-3 donors a day and I suggested we should test EVERY donor for COVID-19
    if COVID-19 enters a transplant unit then this means serious morbidity and mortality
    please share your countries standards
    thanks
    Wojtek Karolak
    Gdansk Lung Transplant Program

    Virus-free. www.avg.com





  • 8.  RE: COVID and challenges in transplantation

    Posted 03-15-2020 05:21
    In Italy as well all donors are tested, both with swab and with BAL. So far no positive COVID has been reported

    ------------------------------
    Luciano Potena
    Bologna
    0512143702
    ------------------------------



  • 9.  RE: COVID and challenges in transplantation

    Posted 03-15-2020 12:39

    That is surprising that no donors at all have been positive. Does this include BAL samples for lungs?

    thank you

     

    Reda Girgis, MD

    Spectrum Health Lung Transplant Program

    Grand Rapids, MI, USA

     






  • 10.  RE: COVID and challenges in transplantation

    Posted 03-15-2020 12:52
    Not that surprising: those data refers to donors procured within March 8. The absolute prevalence of COVID positive subjects in the general population is not high, and ICUs in areas overwhelmed by COVID cases may be procuring less than usual.

    ------------------------------
    Luciano Potena
    Bologna
    0512143702
    ------------------------------



  • 11.  RE: COVID and challenges in transplantation

    Posted 03-16-2020 04:05

    Hi everyone

    In France, all donors are tested, both with swab and with BAL as in Italy

    Eric Epailly

    Strasbourg France






  • 12.  RE: COVID and challenges in transplantation

    Posted 03-14-2020 05:56
    Edited by Lucas Van Aelst 03-14-2020 05:57
    Dear Sophia,

    This is the policy of the Belgian Transplantation Society (member of Eurotransplant):

    https://www.transplant.be/news/read/belgian-transplantation-society-consensus-meeting-on-covid-19-11-03-2020 (website in English)

    For organ-donors:

    • The BTS strongly recommends that every organ donor should be screened for COVID-19
    • Every Belgian Transplantation center should explore internally the practical possibilities for this screening
    • This screening might imply a delay in organizing the procurement procedure
    • This possible delay should be communicated by the transplantation centers to their collaborating regional hospitals
    • If screening is not possible (e.g. donor instability) or the screening results are not available in due time, organ allocation will be sent out without screening results. Otherwise, good donors could be missed.
    • Every accepting hospital has the final decision whether or not to accept an organ with the at that time available information, in this decision the urgency of the transplantation is balanced against the risk of transmission.

    For organ-recipients:

    • When called for a transplantation, the BTS recommends that every organ recipient should be screened for COVID-19 when it is possible to delay the transplantation (or even procurement procedure) till the screening results are available.
    • When a patient is called in for a transplantation, usually a chest-Rx is performed. However CT-scan thorax is much more sensitive to detect early lung lesions. The BTS advices therefore to perform a CT-thorax in the immediate pretransplant evaluation, instead of chest-Rx.
    • If an organ is offered from abroad and screening of the is not possible, the accepting center has the prerogative to decide whether to accept the organ or not, balancing urgency of the transplantation against risk

    All the best,
    Lucas Van Aelst MD PhD

    Department of Cardiovascular Diseases
    Heart Failure and Cardiac Transplantation
    UZ Leuven | campus Gasthuisberg | Herestraat 49 | 3000 Leuven - Belgium | www.uzleuven.be

    ------------------------------
    Lucas Van Aelst
    Gent
    0032476587417
    ------------------------------



  • 13.  RE: COVID and challenges in transplantation

    Posted 03-14-2020 06:54
    Edited by George Ayoub 03-14-2020 09:08
    We have done this weeks 3 transplants of which the donor was negative tested for COVID19. This will be a standard procedure at Eurotransplant zone and hopefully outside this zone. We have now a strict policy regarding visitors and our co-workers to protect our patients and ourselves.

    ------------------------------
    George Ayoub
    Transplant surgeon / Cardio-thoracic surgeon
    University Hospital Essen
    Germany
    ------------------------------



  • 14.  RE: COVID and challenges in transplantation

    Posted 03-15-2020 07:16
      |   view attached
    Herein attached COVID-19 transplant selection criteria by Singapore. Sharing by Dr. Cumara Sivathasan.
    Potentially useful.
    Best
    Antonio






    Bologna S. Orsola University Hospital, Italy
    +390512149043
    +393384395425


    ------------------------------
    Antonio Loforte
    Dr
    Bologna
    0512149043
    ------------------------------



  • 15.  RE: COVID and challenges in transplantation

    Posted 03-21-2020 16:19
    In the AST forum, George Mazariegos posted a link to a preprint from Dr D'Antiga in Bergamo.  In their preliminary report (based on observing limited disease in an endemic area with with a large cohort of immunosuppressed patients), the authors concluded that in their population immunosuppressed patients were not at increased risk for severe pulmonary disease compared to the general population.



    ------------------------------
    Stuart Sweet
    ------------------------------



  • 16.  RE: COVID and challenges in transplantation

    Posted 03-22-2020 01:20
    1) Donors / Transplants  - We are now testing all donors - not accepting organs unless COVID-19 negative. And testing recipients for COVID-19 when donor organ identified. (So testing donor and recipient at same time.) Transplant this week with both donor and recipient testing negative.
    2) Office visits - have converted almost all pre and post visits to video visits. Mailed out home spirometers. Minimized surveillance procedures in post lung transplant patients.
    3) Inpatient visits - minimized number of people entering room. Minimizing labs and x-rays / procedures.
    4) COVID-19 patient - Our first post-lung transplant has tested positive for COVID-19 today. 4.5 years post transplant on Prednisone, MMF, and Tac. Now 5-6 days of symptoms with fever, chills, dry cough and myalgias. CXR without any opacities. On room air maintaining oxygen saturations >95%. Hospitalized for close monitoring.

    ------------------------------
    Lorriana Leard
    San Francisco CA
    (415) 476-8287
    ------------------------------



  • 17.  RE: COVID and challenges in transplantation

    Posted 03-22-2020 01:40
    Thank you for sharing, Lorriana! Hopefully your COVID-19 LT patient is better soon. For this current patient, are you planning to adjust immunosuppression while in-house? 

    You stated you are testing both donors and recips prior to LT. What is your turn around time for these tests? Are you doing both donor/recip via nasopharyngeal swab testing? (or maybe donor with BAL?)

    Best, 
    Saima

    Saima Aslam, MD, MS
    Associate Professor
    Medical Director, Solid Organ Transplant Infectious Diseases
    Division of Infectious Diseases and Global Public Health
    University of California, San Diego