Solid organ transplantation programs facing lack of empiric evidence in the COVID-19 pandemic: A By-proxy Society Recommendation Consensus approach
Solid organ transplantation programs facing lack of empiric evidence in the COVID-19 pandemic: A By-proxy Society Recommendation Consensus approach
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DOI：
10.1111/ajt.15933
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发表时间：
2020-05-10
影响因子：
8.8
通讯作者：
Pratschke, Johann
中科院分区：
文献类型：
--
作者：
Ritschl, Paul V.;Nevermann, Nora;Pratschke, Johann
目前的严重急性呼吸综合征冠状病毒2(SARS-CoV-2)大流行对国家卫生保健系统产生了严重影响。鉴于对设施能力的巨大需求，必须解决对所有卫生保健部门的影响。实体器官移植是一个对工作人员、重症监护病房和后续设施要求很高的领域。器官移植的巨大治疗价值必须与卫生保健能力的强制性限制相权衡。此外，在目前的冠状病毒病2019年(新冠肺炎)大流行期间，必须重新评估对免疫抑制受体的管理。在解决这些关键问题时，移植医生面临着完全缺乏科学证据的问题。因此，这项研究的目的是提供一种基于共识的指导方法，来自22个移植社会的个人信息。提取了关键建议，并计算了不同组织之间的共识程度。在暂停非紧急移植程序和活体捐赠计划方面，达成了高度的共识。广泛推荐对捐赠者和受赠者进行系统的聚合酶链式反应检测。此外，我们的分析还包括了更具体的方面(例如，外科外植体团队的筛选和对边缘供体器官的限制使用)。这项研究提供了一种新的方法，在事先没有科学证据的情况下，为卫生保健管理提供知情指导。
The ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has a drastic impact on national health care systems. Given the overwhelming demand on facility capacity, the impact on all health care sectors has to be addressed. Solid organ transplantation represents a field with a high demand on staff, intensive care units, and follow-up facilities. The great therapeutic value of organ transplantation has to be weighed against mandatory constraints of health care capacities. In addition, the management of immunosuppressed recipients has to be reassessed during the ongoing coronavirus disease 2019 (COVID-19) pandemic. In addressing these crucial questions, transplant physicians are facing a total lack of scientific evidence. Therefore, the aim of this study was to offer an approach of consensus-based guidance, derived from individual information of 22 transplant societies. Key recommendations were extracted and the degree of consensus among different organizations was calculated. A high degree of consensus was found for temporarily suspending nonurgent transplant procedures and living donation programs. Systematic polymerase chain reaction-based testing of donors and recipients was broadly recommended. Additionally, more specific aspects (eg, screening of surgical explant teams and restricted use of marginal donor organs) were included in our analysis. This study offers a novel approach to informed guidance for health care management when a priori no scientific evidence is available.