In the Journals

COVID-19 may pose great risk to transplant recipients and their contacts

After considering the ways in which transplant recipients have responded to similar viruses in the past, researchers contended that COVID-19 may induce “severe consequences” in recipients, while also placing their health care teams and family members at risk.

In an article published in the American Journal of Transplantation, Marian G. Michaels, MD, MPH, of the University of Pittsburgh School of Medicine, and colleagues wrote that while “COVID-19 has not [yet] been described in organ transplant recipients or donors,” related viruses — such as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) — can provide insight into the impact of COVID-19 on this patient population.

Citing a fatal case of a liver transplant recipient with SARS who ultimately infected several others, as well as a kidney transplant recipient with MERS-CoV who had no fever and, therefore, did not fit the criteria for diagnosis with the virus, the researchers emphasized the need for caution in performing transplantation at this time.

They argued that because solid organ transplant recipients require immunosuppression, these patients “may be anticipated to have more intense and prolonged shedding of virus, thus potentially increasing the risk of transmission to contacts including health care workers.”

Furthermore, they indicated that experience with previous coronaviruses suggests exposed recipients will likely be infected. According to the researchers, less is known about the risk of transmission from an infected donor to recipient, suggesting that “attention to donor epidemiological risk factors may help to diminish the risk of donor transmitted infection.”

Based on past epidemics, they argued protocols must promptly be developed for the following:

  • targeted screening of patients, visitors and for organ procurement organizations of potential donors;
  • plans for placement and evaluation of recipients with risk factors;
  • backup plans in the event a transplant center is temporarily closed (including consideration of listing at alternate centers if epidemic is “geographically confined”); and
  • development of communication strategies for recipients and potential living donors.

The researchers concluded “the current COVID-19 epidemic is still in its early stages and while acquisition of knowledge is rapidly accumulating, there are many unknowns for the community at large and the transplant community in particular.”

Despite these uncertainties, they wrote, “it is imperative that we anticipate the potential impact on the transplant community in order to avert severe consequences of this infection on both the transplant community and contacts of transplant patients.”

In a letter to the editor published in American Journal of Transplantation, Andrea Gori, MD, and colleagues, who work as transplant and infectious disease specialists at a hospital in Italy, provided a first-hand perspective on COVID-19 and its impact on the transplant community. They support the idea that “all efforts must be carried out to control COVID-19 spread and avoid post-transplant infections, especially during the initial phase of the outbreak.”

They argued that procedures related to transplantation must be updated as more information surfaces, adding it is imperative to quell misinformation to ensure panic does not ensue for patients and their caregivers.

“Yet, facing the outbreak from inside, we cannot afford any underestimation,” they wrote. – by Melissa J. Webb

Disclosures: The authors report no relevant financial disclosures.

After considering the ways in which transplant recipients have responded to similar viruses in the past, researchers contended that COVID-19 may induce “severe consequences” in recipients, while also placing their health care teams and family members at risk.

In an article published in the American Journal of Transplantation, Marian G. Michaels, MD, MPH, of the University of Pittsburgh School of Medicine, and colleagues wrote that while “COVID-19 has not [yet] been described in organ transplant recipients or donors,” related viruses — such as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) — can provide insight into the impact of COVID-19 on this patient population.

Citing a fatal case of a liver transplant recipient with SARS who ultimately infected several others, as well as a kidney transplant recipient with MERS-CoV who had no fever and, therefore, did not fit the criteria for diagnosis with the virus, the researchers emphasized the need for caution in performing transplantation at this time.

They argued that because solid organ transplant recipients require immunosuppression, these patients “may be anticipated to have more intense and prolonged shedding of virus, thus potentially increasing the risk of transmission to contacts including health care workers.”

Furthermore, they indicated that experience with previous coronaviruses suggests exposed recipients will likely be infected. According to the researchers, less is known about the risk of transmission from an infected donor to recipient, suggesting that “attention to donor epidemiological risk factors may help to diminish the risk of donor transmitted infection.”

Based on past epidemics, they argued protocols must promptly be developed for the following:

  • targeted screening of patients, visitors and for organ procurement organizations of potential donors;
  • plans for placement and evaluation of recipients with risk factors;
  • backup plans in the event a transplant center is temporarily closed (including consideration of listing at alternate centers if epidemic is “geographically confined”); and
  • development of communication strategies for recipients and potential living donors.

The researchers concluded “the current COVID-19 epidemic is still in its early stages and while acquisition of knowledge is rapidly accumulating, there are many unknowns for the community at large and the transplant community in particular.”

Despite these uncertainties, they wrote, “it is imperative that we anticipate the potential impact on the transplant community in order to avert severe consequences of this infection on both the transplant community and contacts of transplant patients.”

In a letter to the editor published in American Journal of Transplantation, Andrea Gori, MD, and colleagues, who work as transplant and infectious disease specialists at a hospital in Italy, provided a first-hand perspective on COVID-19 and its impact on the transplant community. They support the idea that “all efforts must be carried out to control COVID-19 spread and avoid post-transplant infections, especially during the initial phase of the outbreak.”

They argued that procedures related to transplantation must be updated as more information surfaces, adding it is imperative to quell misinformation to ensure panic does not ensue for patients and their caregivers.

“Yet, facing the outbreak from inside, we cannot afford any underestimation,” they wrote. – by Melissa J. Webb

Disclosures: The authors report no relevant financial disclosures.

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