Trubin Paul A, Azar Marwan M, Malinis Maricar
Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, PO Box 208022, New Haven, CT 06520-8022 USA.
Curr Transplant Rep. 2020;7(4):390-398. doi: 10.1007/s40472-020-00307-w. Epub 2020 Oct 25.
While a great deal of literature has been published recently on the viral kinetics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and diagnostic testing performance for coronavirus disease 2019 (COVID-19) in the general population, a relative paucity of information has come to light regarding implications of COVID-19 diagnostics for solid organ transplantation. This review examines the current state of knowledge regarding the two principal diagnostic testing strategies for SARS-CoV-2 infection, polymerase chain reaction (PCR)-based testing and serology, and discusses COVID-19 diagnostic implications for solid organ transplantation.
The interpretation of diagnostics for SARS-CoV-2 infection can present several challenges and raises questions regarding optimal donor and candidate screening as well as infection prevention practices in solid organ transplant recipients with SARS-CoV-2 infection. Guidance from several societies regarding donor and recipient suitability for transplantation during the COVID-19 pandemic is reviewed. Prolonged positive testing by polymerase chain reaction has been described in transplant recipients which may impact infection prevention practices.
The COVID-19 pandemic has put multiple aspects of solid organ transplantation at risk, with impacts on donor and recipient suitability, and mitigation of infection and transmission after transplantation. Accumulating evidence regarding diagnostic fidelity and transmissibility of SARS-CoV-2 in immunocompromised patients will continue to inform optimal practices surrounding solid organ transplantation during the COVID-19 pandemic.
尽管近期已发表了大量关于严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的病毒动力学以及普通人群中2019冠状病毒病（COVID-19）诊断检测性能的文献，但关于COVID-19诊断对实体器官移植的影响的信息相对较少。本综述探讨了关于SARS-CoV-2感染的两种主要诊断检测策略，即基于聚合酶链反应（PCR）的检测和血清学的当前知识状态，并讨论了COVID-19诊断对实体器官移植的影响。
SARS-CoV-2感染诊断的解读可能带来若干挑战，并引发了关于最佳供体和候选者筛查以及SARS-CoV-2感染的实体器官移植受者感染预防措施的问题。综述了几个学会关于COVID-19大流行期间供体和受者移植适宜性的指导意见。已报道移植受者中聚合酶链反应检测呈阳性的时间延长，这可能会影响感染预防措施。
COVID-19大流行使实体器官移植的多个方面面临风险，对供体和受者的适宜性以及移植后感染和传播的缓解产生影响。关于SARS-CoV-2在免疫受损患者中的诊断准确性和传播性的越来越多的证据将继续为COVID-19大流行期间实体器官移植的最佳实践提供参考。
