General Approach to the Clinical Care of Solid Organ Transplant Recipients with COVID-19 Infection
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COVID19 AND TRANSPLANTATION (R AVERY, SECTION EDITOR)
General Approach to the Clinical Care of Solid Organ Transplant Recipients with COVID-19 Infection Management for Transplant Recipients Min Young Kim 1
&
Daniel C. Brennan 1
&
Pali Shah 1,2
Accepted: 12 October 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review Insufficient knowledge about COVID-19 and the potential risks of COVID-19 are limiting organ transplantation in wait-listed candidates and deferring essential health care in solid organ transplant recipients. In this review, we expand the understanding and present an overview of the optimized management of COVID-19 in solid organ transplant recipients. Recent Findings Transplant recipients are at an increased risk of severe COVID-19. The unique characteristics of transplant recipients can make it more difficult to identify COVID-19. Based on the COVID-19 data to date and our experience, we present testing, management, and prevention methods for COVID-19. Comprehensive diagnostic tests should be performed to determine disease severity, phase of illness, and identify other comorbidities in transplant recipients diagnosed with COVID-19. Outpatients should receive education for preventative measures and optimal health care delivery minimizing potential infectious exposures. Multidisciplinary interventions should be provided to hospitalized transplant recipients for COVID-19 because of the complexity of caring for transplant recipients. Summary Transplant recipients should strictly adhere to infection prevention measures. Understanding of the transplant specific pathophysiology and development of effective treatment strategies for COVID-19 should be prioritized. Keywords COVID-19 . Transplant recipient . Prevention . Management
Introduction The coronavirus disease 2019 (COVID-19) pandemic has led to unique challenges in solid organ transplantation as centers balance the risk of caring for immunosuppressed patients with the best timing and urgency of transplantation. Insufficient knowledge about COVID-19 and the potential risks of COVID-19 for transplant donors and recipients are limiting organ transplantation as well as research in transplantation [1–3]. However, transplantation is essential for lifesaving This article is part of the Topical Collection on COVID19 and Transplantation * Pali Shah [email protected] 1
Department of Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
2
Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
transplants of heart, lung, or liver and for deceased donor kidney transplantations (KT) in candidates with a lack of dialysis access or who are highly sensitized [4]. To assist in the timing of transplantation during the COVID-19 pandemic, Massie et al. developed a model for mortality of wait-listed patients and transplant recipients in relation to COVID-19 [5]. Kidney transplantation (KT) reliably provides survival benefit unless mortality risk for KT recipients exposed to
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