Organización Nacional de Trasplantes, Madrid, Spain.
Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.
Transplantation. 2021 Jan 1;105(1):29-36. doi: 10.1097/TP.0000000000003528.
Spain has been amongst the countries most affected by the COVID-19 pandemic, which has posed significant challenges to the donation and transplantation program. Despite a dramatic decrease of donation and transplantation activities during the critical early weeks of the outbreak, the program has recovered and is learning to cope with COVID-19.
We describe the 4 pillars upon which the Spanish donation and transplantation program has been rebuilt.
(1) Standards have been developed and progressively updated for the evaluation and selection of potential donors and recipients with regards to SARS-CoV-2 infection. (2) Spain has been actively generating evidence to assess the validity of our standards and to understand the natural history of the infection in transplant recipients. No case of donor-derived COVID-19 has been reported to date. COVID-19 has been more frequent and has had a more aggressive course in recipients of solid organ transplants than in the general population, but this seems largely explained by the demographics and comorbidity of transplant patients. (3) As a result of this evidence and experience, recommendations have been issued for the management of COVID-19 in solid organ transplant recipients and candidates on the waiting list. (4) Finally, concrete guidance has been issued for centers to manage the donation and transplantation programs in relation to a dynamic and heterogeneous epidemiologic scenario.
The Spanish experience confronting the impact of COVID-19 upon donation and transplantation may help serve the needs of a broader community in other countries.
西班牙是受 COVID-19 大流行影响最严重的国家之一，这给捐赠和移植项目带来了重大挑战。尽管在疫情爆发的关键早期几周，捐赠和移植活动急剧减少，但该项目已经恢复，并正在学习应对 COVID-19。
我们描述了西班牙捐赠和移植项目重建的 4 个支柱。
(1) 针对 SARS-CoV-2 感染，制定并逐步更新了评估和选择潜在供体和受者的标准。(2) 西班牙一直在积极生成证据，以评估我们的标准的有效性，并了解移植受者中感染的自然史。迄今为止，尚未报告有供体源性 COVID-19 的病例。COVID-19 在实体器官移植受者中的发生频率更高，且病程更具侵袭性，比一般人群更为常见，但这在很大程度上可以用移植患者的人口统计学和合并症来解释。(3) 由于这些证据和经验，已发布了有关实体器官移植受者和候补名单上 COVID-19 管理的建议。(4) 最后，针对动态和异质的流行病学情况，为中心发布了管理捐赠和移植项目的具体指导。
西班牙在应对 COVID-19 对捐赠和移植的影响方面的经验可能有助于满足其他国家更广泛社区的需求。
