Lentine Krista L, Vest Luke S, Schnitzler Mark A, Mannon Roslyn B, Kumar Vineeta, Doshi Mona D, Cooper Matthew, Mandelbrot Didier A, Harhay Meera N, Josephson Michelle A, Caliskan Yasar, Sharfuddin Asif, Kasiske Bertram L, Axelrod David A
Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA.
Department of Medicine, University of Nebraska, Omaha, Nebraska, USA.
Kidney Int Rep. 2020 Nov;5(11):1894-1905. doi: 10.1016/j.ekir.2020.08.017. Epub 2020 Aug 25.
The scope of the impact of the coronavirus disease 2019 (COVID-19) pandemic on living donor kidney transplantation (LDKT) practices is not well defined.
We surveyed US transplant programs to assess practices, strategies, and barriers to living LDKT during the COVID-19 pandemic. After institutional review board approval, the survey was distributed from 9 May 2020 to 30 May 2020 by e-mail and postings to professional society list-servs. Responses were stratified based on state COVID-19 cumulative incidence levels.
Staff at 118 unique centers responded, representing 61% of US living donor recovery programs and 75% of LKDT volume in the prepandemic year. Overall, 66% reported that LDKT surgery was on hold (81% in "high" vs. 49% in "low" COVID-19 cumulative incidence states). A total of 36% reported that evaluation of new donor candidates had paused, 27% reported that evaluations were very much decreased (>0% to <25% typical), and 23% reported that evaluations were moderately decreased (25% to <50% typical). Barriers to LDKT surgery included program concerns for donor (85%) and recipient (75%) safety, patient concerns (56%), elective case restrictions (47%), and hospital administrative restrictions (48%). Programs with higher local COVID-19 cumulative incidence reported more barriers related to staff and resource diversion. Most centers continuing donor evaluations used remote strategies (video, 82%; telephone, 43%). As LDKT resumes, all programs will screen for COVID-19, although timeframe and modalities will vary. Recommendations for presurgical self-quarantine are also variable.
The COVID-19 pandemic has had broad impacts on LDKT practice. Ongoing research and consensus building are needed to reduce barriers, to guide optimal practices, and to support safe restoration of LDKT across centers.
2019年冠状病毒病（COVID-19）大流行对活体供肾移植（LDKT）实践的影响范围尚不明确。
我们对美国的移植项目进行了调查，以评估COVID-19大流行期间活体LDKT的实践、策略和障碍。经机构审查委员会批准后，于2020年5月9日至2020年5月30日通过电子邮件和发布到专业协会邮件列表的方式分发了调查问卷。根据各州COVID-19累计发病率水平对回复进行分层。
118个独立中心的工作人员做出了回应，占美国活体供体恢复项目的61%，以及大流行前一年LKDT量的75%。总体而言，66%的中心报告称LDKT手术已暂停（COVID-19累计发病率“高”的州为81%，“低”的州为49%）。共有36%的中心报告称对新供体候选人的评估已暂停，27%的中心报告称评估大幅减少（降至正常水平的0%至<25%），23%的中心报告称评估适度减少（降至正常水平的25%至<50%）。LDKT手术的障碍包括项目对供体（85%）和受体（75%）安全的担忧、患者的担忧（56%）、择期病例限制（47%）以及医院行政限制（48%）。当地COVID-19累计发病率较高的项目报告了更多与工作人员和资源转移相关的障碍。大多数继续进行供体评估的中心采用了远程策略（视频，82%；电话，43%）。随着LDKT恢复，所有项目都将对COVID-19进行筛查，尽管时间框架和方式会有所不同。术前自我隔离的建议也各不相同。
COVID-19大流行对LDKT实践产生了广泛影响。需要持续开展研究并建立共识，以减少障碍、指导最佳实践，并支持各中心安全恢复LDKT。
