Division of Transplantation, Department of Surgery, Penn Transplant Institute, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, USA.
Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Transpl Int. 2021 Jun;34(6):1019-1031. doi: 10.1111/tri.13860. Epub 2021 May 5.
The increasing global prevalence of SARS-CoV-2 and the resulting COVID-19 disease pandemic pose significant concerns for clinical management of solid organ transplant recipients (SOTR). Wearable devices that can measure physiologic changes in biometrics including heart rate, heart rate variability, body temperature, respiratory, activity (such as steps taken per day) and sleep patterns, and blood oxygen saturation show utility for the early detection of infection before clinical presentation of symptoms. Recent algorithms developed using preliminary wearable datasets show that SARS-CoV-2 is detectable before clinical symptoms in >80% of adults. Early detection of SARS-CoV-2, influenza, and other pathogens in SOTR, and their household members, could facilitate early interventions such as self-isolation and early clinical management of relevant infection(s). Ongoing studies testing the utility of wearable devices such as smartwatches for early detection of SARS-CoV-2 and other infections in the general population are reviewed here, along with the practical challenges to implementing these processes at scale in pediatric and adult SOTR, and their household members. The resources and logistics, including transplant-specific analyses pipelines to account for confounders such as polypharmacy and comorbidities, required in studies of pediatric and adult SOTR for the robust early detection of SARS-CoV-2, and other infections are also reviewed.
全球范围内 SARS-CoV-2 的不断流行以及由此导致的 COVID-19 疾病大流行，对实体器官移植受者（SOTR）的临床管理构成了重大关切。可测量心率、心率变异性、体温、呼吸、活动（如每天的步数）和睡眠模式等生物特征变化的可穿戴设备，对于在出现症状之前早期检测感染具有实用价值。最近使用初步可穿戴数据集开发的算法表明，在 >80%的成年人中，SARS-CoV-2 在出现临床症状之前即可检测到。早期检测 SOTR 及其家庭成员中的 SARS-CoV-2、流感和其他病原体，可以促进早期干预措施，如自我隔离和对相关感染的早期临床管理。本文回顾了正在进行的测试智能手表等可穿戴设备在普通人群中早期检测 SARS-CoV-2 和其他感染的实用性的研究，以及在儿科和成年 SOTR 及其家庭成员中大规模实施这些流程所面临的实际挑战。还回顾了资源和后勤方面的问题，包括为了在 SARS-CoV-2 和其他感染的早期检测中考虑到多药治疗和合并症等混杂因素而进行的移植特异性分析管道，这些都是在儿科和成年 SOTR 中进行研究所需的。
