Department of Digestive Surgery and Transplantation, University Hospital Croix Rousse, Hospices Civils de Lyon, University of Lyon I, Lyon, France.
Department of Hepatology, University Hospital Croix Rousse, Hospices Civils de Lyon, University of Lyon I, Lyon, France.
Am J Transplant. 2020 Nov;20(11):2989-2996. doi: 10.1111/ajt.16082. Epub 2020 Jul 5.
Liver transplantation (LT) during the ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is challenging given the urgent need to reallocate resources to other areas of patient care. Available guidelines recommend reorganizing transplant care, but data on clinical experience in the context of SARS-CoV-2 pandemic are scarce. Thus, we report strategies and preliminary results in LT during the peak of the SARS-CoV-2 pandemic from a single center in France. Our strategy to reorganize the transplant program included 4 main steps: optimization of available resources, especially intensive care unit capacity; multidisciplinary risk stratification of LT candidates on the waiting list; implementation of a systematic SARS-CoV-2 screening strategy prior to transplantation; and definition of optimal recipient-donor matching. After implementation of these 4 steps, we performed 10 successful LTs during the peak of the pandemic with a short median intensive care unit stay (2.5 days), benchmark posttransplant morbidity, and no occurrence of SARS-CoV-2 infection during follow-up. From this preliminary experience we conclude that efforts in resource planning, optimal recipient selection, and organ allocation strategy are key to maintain a safe LT activity. Transplant centers should be ready to readapt their practices as the pandemic evolves.
在持续的严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 大流行期间进行肝移植 (LT) 具有挑战性，因为需要将资源紧急重新分配到患者护理的其他领域。现有指南建议重新组织移植护理，但关于 SARS-CoV-2 大流行背景下临床经验的数据却很少。因此，我们报告了法国一家中心在 SARS-CoV-2 大流行高峰期进行 LT 的策略和初步结果。我们重组移植项目的策略包括 4 个主要步骤：优化现有资源，特别是重症监护病房的容量；对等待名单上的 LT 候选者进行多学科风险分层；在移植前实施系统的 SARS-CoV-2 筛查策略；并确定最佳的受者-供者匹配。实施这 4 个步骤后，我们在大流行高峰期成功进行了 10 例 LT，重症监护病房停留时间中位数短（2.5 天），移植后发病率基准高，随访期间未发生 SARS-CoV-2 感染。从这初步经验中，我们得出结论，在资源规划、优化受者选择和器官分配策略方面的努力是维持安全 LT 活动的关键。随着大流行的发展，移植中心应准备好调整其做法。
