Early impact of COVID-19 on transplant center practices and policies in the United States
Early impact of COVID-19 on transplant center practices and policies in the United States
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DOI：
10.1111/ajt.15915
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发表时间：
2020-05-10
影响因子：
8.8
通讯作者：
Garonzik-Wang, Jacqueline M.
中科院分区：
文献类型：
--
作者：
Boyarsky, Brian J.;Po-Yu Chiang, Teresa;Garonzik-Wang, Jacqueline M.
新冠肺炎是一种新的、快速变化的流行病：因此，实体器官移植的循证建议仍然具有挑战性和不确定性。为了了解对全美移植活动的影响，以及测试、临床实践和政策方面的中心水平差异，我们在2020年3月24日至2020年3月31日期间进行了一项全国调查，并将反应与新冠肺炎发病地图联系起来。回复率高达79.3%，反映出国家高度重视更好地理解新冠肺炎。完全中止活体供肾移植占71.8%，活体供肝占67.7%。虽然完全暂停已故供体移植的频率较低，但对已故供体肾移植的限制占84.0%，对已故供体肝脏移植的限制占73.3%；限制越严格，新冠肺炎的区域发病率越高。报告新冠肺炎检测短缺的比例为42.5%。受访者报告说，在移植后10年，共有148名新冠肺炎接受者：69.6%是肾脏接受者，25.0%是危重患者。78.1%的受访者使用了羟基氯喹，46.9%的人使用了阿奇霉素，31.3%的人使用了托西珠单抗，25.0%的人使用了瑞维。全美中心层面的反应存在广泛的异质性；正在进行的国家数据收集、专家讨论和临床研究对于提供循证实践的信息至关重要。
COVID-19 is a novel, rapidly changing pandemic: consequently, evidence-based recommendations in solid organ transplantation (SOT) remain challenging and unclear. To understand the impact on transplant activity across the United States, and center-level variation in testing, clinical practice, and policies, we conducted a national survey between March 24, 2020 and March 31, 2020 and linked responses to the COVID-19 incidence map. Response rate was a very high 79.3%, reflecting a strong national priority to better understand COVID-19. Complete suspension of live donor kidney transplantation was reported by 71.8% and live donor liver by 67.7%. While complete suspension of deceased donor transplantation was less frequent, some restrictions to deceased donor kidney transplantation were reported by 84.0% and deceased donor liver by 73.3%; more stringent restrictions were associated with higher regional incidence of COVID-19. Shortage of COVID-19 tests was reported by 42.5%. Respondents reported a total of 148 COVID-19 recipients from 10 years posttransplant: 69.6% were kidney recipients, and 25.0% were critically ill. Hydroxychloroquine (HCQ) was used by 78.1% of respondents; azithromycin by 46.9%; tocilizumab by 31.3%, and remdesivir by 25.0%. There is wide heterogeneity in center-level response across the United States; ongoing national data collection, expert discussion, and clinical studies are critical to informing evidence-based practices.