Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, Padua Italy.
Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
J Hepatol. 2022 Feb;76(2):364-370. doi: 10.1016/j.jhep.2021.09.041. Epub 2021 Oct 13.
The global impact of SARS-CoV-2 on liver transplantation (LT) practices across the world is unknown. The goal of this survey was to assess the impact of the pandemic on global LT practices.
A prospective web-based survey (available online from 7 September 2020 to 31 December 2020) was proposed to the active members of the EASL-ESOT/ELITA-ILTS in the Americas (including North, Central, and South America) (R1), Europe (R2), and the rest of the world (R3). The survey comprised 4 parts concerning transplant processes, therapy, living donors, and organ procurement.
Of the 470 transplant centers reached, 128 answered each part of the survey, 29 centers (23%), 64 centers (50%), and 35 centers (27%) from R1, R2, and R3, respectively. When we compared the practices during the first 6 months of the pandemic in 2020 with those a year earlier in 2019, statistically significant differences were found in the number of patients added to the waiting list (WL), WL mortality, and the number of LTs performed. At the regional level, we found that in R2 the number of LTs was significantly higher in 2019 (p <0.01), while R3 had more patients listed, higher WL mortality, and more LTs performed before the pandemic. Countries severely affected by the pandemic ("hit" countries) had a lower number of WL patients (p = 0.009) and LTs (p = 0.002) during the pandemic. Interestingly, WL mortality was still higher in the "non-hit" countries in 2020 compared to 2019 (p = 0.022).
The first wave of the pandemic differentially impacted LT practices across the world, especially with detrimental effects on the "hit" countries. Modifications to the policies of recipient and donor selection, organ retrieval, and postoperative recipient management were adopted at a regional or national level.
The health emergency caused by the coronavirus pandemic has dramatically changed clinical practice during the pandemic. The first wave of the pandemic impacted liver transplantation differently across the world, with particularly detrimental effects on the countries badly hit by the virus. The resilience of the entire transplant network has enabled continued organ donation and transplantation, ultimately improving the lives of patients with end-stage liver disease.
目前尚不清楚 SARS-CoV-2 对全球范围内肝移植（LT）实践的全球影响。本研究旨在评估疫情对全球 LT 实践的影响。
我们向美洲（包括北美、中美和南美）（R1）、欧洲（R2）和世界其他地区（R3）的 EASL-ESOT/ELITA-ILTS 活跃成员提出了一项前瞻性的在线调查（从 2020 年 9 月 7 日至 2020 年 12 月 31 日在线）。该调查由 4 部分组成，涉及移植过程、治疗、活体供者和器官获取。
在联系的 470 个移植中心中，有 128 个中心回答了调查的每一部分，分别有 29 个（23%）、64 个（50%）和 35 个（27%）中心来自 R1、R2 和 R3。当我们将 2020 年疫情前 6 个月与 2019 年同期的实践进行比较时，我们发现等待名单（WL）中患者人数、WL 死亡率和 LT 数量有统计学意义的差异。在区域层面，我们发现 R2 中 2019 年 LT 数量明显更高（p<0.01），而 R3 在疫情前的 WL 患者人数更多，WL 死亡率更高，LT 数量更多。受疫情严重影响的国家（“受影响”国家）在疫情期间 WL 患者（p=0.009）和 LT （p=0.002）数量较少。有趣的是，2020 年“非受影响”国家的 WL 死亡率仍高于 2019 年（p=0.022）。
疫情的第一波浪潮对全球 LT 实践产生了不同的影响，特别是对“受影响”国家产生了不利影响。在区域或国家层面上，对受者和供者选择、器官获取以及术后受者管理的政策进行了修改。
由冠状病毒大流行引起的卫生紧急情况极大地改变了疫情期间的临床实践。疫情的第一波浪潮对全球范围内的肝移植产生了不同的影响，对受病毒严重影响的国家造成了特别不利的影响。整个移植网络的弹性使器官捐赠和移植得以持续，最终改善了终末期肝病患者的生活。
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