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Daoud A, Soliman K, Posadas Salas MA, Uehara G, Vaishnav S, Cheungpasitporn W, Casey MJ. COVID-19 and renal allograft rejection: insight from controlled and non-controlled studies. Ren Fail 2024; 46:2336126. [PMID: 38627208 PMCID: PMC11022909 DOI: 10.1080/0886022x.2024.2336126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/22/2024] [Indexed: 04/19/2024] Open
Abstract
AIM Kidney transplant recipients (KTRs), due to their immunosuppressed status, are potentially more susceptible to both the severe effects of COVID-19 and complications in their transplanted organ. The aim of this study is to investigate whether COVID-19 infection increases the risk of rejection in kidney transplant recipients (KTRs). METHODS This study involved a detailed literature review, conducted using PubMed, with the search being completed by September 7th, 2023. The search strategy incorporated a combination of relevant keywords: 'COVID', 'Renal', 'Kidney', 'Transplant', and 'Rejection'. The results from controlled and uncontrolled studies were separately collated and analyzed. RESULTS A total of 11 studies were identified, encompassing 1,179 patients. Among these, two controlled studies reported the incidence of rejection in KTRs infected with COVID-19. Pooling data from these studies revealed no significant statistical correlation between COVID-19 infection and biopsy-proven rejection (p = 0.26). In addition, nine non-controlled studies were found, with rejection incidences ranging from 0% to 66.7%. The majority of these studies (eight out of nine) had small sample sizes, ranging from 3 to 75 KTRs, while the largest included 372 KTRs. The combined rejection rate across these studies was calculated to be 11.8%. CONCLUSION In conclusion, the limited number of published controlled studies revealed no statistically significant association between COVID-19 infection and biopsy-proven rejection among KTRs. However, the broader analysis of non-controlled studies showed a variable rejection incidence with a pooled rejection rate of 11.8%. There is insufficient high-quality data to explore the association of COVID-19 infection and rejection.
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Affiliation(s)
- Ahmed Daoud
- Medical University of South Carolina, Charleston, SC, USA
- Division of Nephrology, Cairo University Medical School, Cairo, Egypt
| | - Karim Soliman
- Medical University of South Carolina, Charleston, SC, USA
- Medical Services, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | | | - Genta Uehara
- Medical University of South Carolina, Charleston, SC, USA
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Sever MS, Vanholder R, Oniscu G, Abramowicz D, Van Biesen W, Maggiore U, Watschinger B, Mariat C, Buturovic-Ponikvar J, Crespo M, Mjoen G, Heering P, Peruzzi L, Gandolfini I, Hellemans R, Hilbrands L. Kidney transplantation during mass disasters - from COVID-19 to other catastrophes A Consensus Statement by the DESCARTES Working Group and Ethics Committee of the ERA. Nephrol Dial Transplant 2023; 38:300–308. [PMID: 36066915 PMCID: PMC9923698 DOI: 10.1093/ndt/gfac251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Indexed: 07/23/2023] Open
Abstract
Mass disasters are characterized by a disparity between health care demand and supply, which hampers complex therapies like kidney transplantation. Considering scarcity of publications on previous disasters, we reviewed transplantation practice during the recent COVID-19 pandemic, and dwelled upon this experience for guiding transplantation strategies in the future pandemic and non-pandemic catastrophes. We strongly suggest continuing transplantation programs during mass disasters, if medical and logistic operational circumstances are appropriate. Postponing transplantations from living donors and referral of urgent cases to safe regions or hospitals are justified. Specific preventative measures in anticipated disasters (such as vaccination programs during pandemics or evacuation in case of hurricanes or wars) may be useful to minimize risks. Immunosuppressive therapies should consider stratifying risk status and avoiding heavy immune suppression in patients with a low probability of therapeutic success. Discharging patients at the earliest convenience is justified during pandemics, whereas delaying discharge is reasonable in other disasters, if infrastructural damage results in unhygienic living environments for the patients. In the outpatient setting, telemedicine is a useful approach to reduce the patient load to hospitals, to minimize the risk of nosocomial transmission in pandemics and the need for transport in destructive disasters. If it comes down to save as many lives as possible, some ethical principles may vary in function of disaster circumstances, but elementary ethical rules are non-negotiable. Patient education is essential to minimize disaster-related complications and to allow for an efficient use of health care resources.
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Affiliation(s)
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium; Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | | | | | - Wim Van Biesen
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Umberto Maggiore
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Bruno Watschinger
- Medical University of Vienna, Department of Medicine III, Division of Nephrology and Dialysis, Vienna, Austria
| | - Christophe Mariat
- Service de Néphrologie, Dialyse et Transplantation rénale, Centre Hospitalier Universitaire de Saint Etienne, Hôpital NORD, Université de Lyon, Université Jean Monnet, Saint Etienne, France
| | | | - Marta Crespo
- Hospital del Mar, Department of Nephrology, Barcelona, Spain
| | - Geir Mjoen
- Section of Nephrology, Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway
| | - Peter Heering
- Klinik für Nephrologie und Allgemeine Innere Medizin, Städtisches Klinikum Solingen, Solingen, Germany
| | | | | | - Rachel Hellemans
- Department of Nephrology and Hypertension, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Luuk Hilbrands
- Radboud university medical center, Department of Nephrology, Nijmegen, The Netherlands
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The effect of the COVID-19 pandemic on deceased and living organ donors in the United States of America. Sci Rep 2022; 12:20651. [PMID: 36450817 PMCID: PMC9709750 DOI: 10.1038/s41598-022-24351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
A life-saving treatment, solid organ transplantation (SOT) has transformed the survival and quality of life of patients with end-organ dysfunction. The coronavirus disease (COVID-19) pandemic has impacted the practice of deceased and living donations worldwide by various resource shifting, including healthcare personnel and equipment such as ventilators and bed space. Our work explores the COVID-19 pandemic and global transplant data to create a statistical model for deducing the impact of COVID-19 on living donor and deceased donor transplants in the United States of America (USA). In severely impacted regions, transplant centers need to carefully balance the risks and benefits of performing a transplant during the COVID-19 pandemic. In our statistical model, the COVID cases are used as an explanatory variable (input) to living or deceased donor transplants (output). The model is shown to be statistically accurate for both estimation of the correlation structure, and prediction of future donors. The provided predictions are to be taken as probabilistic assertions, so that for each instant where the prediction is calculated, a statistical measure of accuracy (confidence interval) is provided. The method is tested on both low and high frequency data, that notoriously exhibit a different behavior.
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Molnar MZ, Hall IE, Raghavan D, Shihab F, Imlay H, Hanson KE, Gomez CA, Campsen J, Kim R, Baker N, Rofaiel G. Kidney transplantation from SARS-CoV-2-positive deceased donor. Am J Transplant 2022; 22:1280-1282. [PMID: 34859572 PMCID: PMC9811910 DOI: 10.1111/ajt.16905] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Miklos Z. Molnar
- Division of Nephrology and Hypertension, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Isaac E. Hall
- Division of Nephrology and Hypertension, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Divya Raghavan
- Division of Nephrology and Hypertension, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Fuad Shihab
- Division of Nephrology and Hypertension, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Hannah Imlay
- Division of Infectious Disease, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Kimberly E. Hanson
- Division of Infectious Disease, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Carlos A. Gomez
- Division of Infectious Disease, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jeffrey Campsen
- Division of Transplantation and Advanced Hepatobiliary Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Robin Kim
- Division of Transplantation and Advanced Hepatobiliary Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Nicholas Baker
- Division of Transplantation and Advanced Hepatobiliary Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - George Rofaiel
- Division of Transplantation and Advanced Hepatobiliary Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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