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CovidReference.com Aug;7(8):e601-e612. PubMed: https://pubmed.gov/32563283. Full-text: https://doi.org/10.1016/S2352-3026(20)30205-2
Transplantation During a health crisis such as the COVID pandemic, it is crucial to carefully balance cost and benefits in performing organ transplantation (Andrea 2020). There is no doubt that the current situation has deeply affected organ donation and that this represents an important collateral damage of the pandemic. All Eurotransplant countries have implemented preventive screenings policies for potential organ donors. For detailed information on the national policy, please visit https://www.eurotransplant.org/2020/04/07/covid-19-andorgan-donation/. Preliminary data indicate a significant reduction in transplantation rates even in regions where COVID-19 cases are low, suggesting a global and nationwide effect beyond the local COVID-19 infection prevalence (Loupy 2020). During March and April, the overall reduction in deceased donor transplantations since the COVID-19 outbreak was 91% in France and 51% in the USA, respectively. In both France and the USA, this reduction was mostly driven by kidney transplantation, but a substantial effect was also seen for heart, lung, and liver transplants, all of which provide meaningful improvement in survival probability. In Germany, however, compared with the previous year, the cumulative numbers of deceased organ donors and transplants showed no significant reduction (Qu 2020). Solid organ transplant recipients are generally at higher risk for complications of respiratory viral infections (in particular influenza), due to their chronic immunosuppressive regimen, and this may hold particularly true for SARS-CoV-2 infection. The first cohort of COVID-19 in transplant recipients from the US indeed indicated that transplant recipients appear to have more severe outcomes (Pereira 2020). Some key studies: Liver: In the largest cohort, 16/100 patients died from COVID-19. Of note, mortality was observed only in patients aged 60 years or older (16/73) and was more common in males than in females (Belli 2020). Although not statistically significant, more patients who were transplanted at least 2 years earlier died than did those who received their transplant within the past 2 years (18% vs 5%). A systematic search on June 15 revealed 223 liver transplant recipients with COVID-19 in 15 studies (Fraser 2020). The case fatality rate was 19,3%. Dyspnea on presentation, diabetes mellitus, and age 60 years or older were significantly associated with increased mortality (p = 0.01) with a trend to a higher mortality rate observed in those with hypertension and those receiving corticosteroids at the time of COVID-19 diagnosis. However, in a mulKamps – Hoffmann
