ABSTRACT
Purpose: It has been proposed that patients with intestinal failure (IF) and intestine transplant (IT) are at higher risk of severe complications of COVID-19 due to weakened immunity and comorbidities. Multidisciplinary teams had to adapt their clinical approaches in order to keep these patients as safe as possible during the pandemic. Data is lacking. Method(s): Retrospective, observational, multicenter study performed with 3 surveys to assess COVID-19 practice changes in IF and IT patients. Result(s): 17 centers were included in the analysis;six had a 3 (+/- 4) months moratorium on performing transplant. Nine delayed their routine follow up including "protocol" biopsies. Nine reported decrease in new referrals. Sixteen incorporated telemedicine. Two reported rehabilitation services (home health, PN deliveries) being affected. In the first survey, 10 centers (59%) reported having IF and IT patients with COVID-19. In the other 2 surveys, a total of 25 IF and IT patients were reported positive for COVID-19. Of the 11 IF patients, 8 were male;7 were adults, with a mean age of 60 (+/- 8) years. Nine of them were symptomatic at presentation, with the most prevalent symptoms being fever/chills, cough and sore throat;hospitalization was required in 45.5%, all patients survived. A total of 14 IT patients were positive;8 were female;all of them were adults, mean age: 47 (+/- 16) years. All of them were symptomatic at presentation, with the most prevalent symptoms being fever/chills, dyspnea and cough. Hospitalization was required in 50%. Immunosuppression was discontinued in 1 patient, decreased in 5 (all on tacrolimus), and left unchanged in 8 cases;3 patients (21%) died. Conclusion(s): Many aspects of healthcare have been impacted by the COVID-19 pandemic. Centers adapted to new paradigms in patient care. Despite the availability of telemedicine, hospitals that treat IF and IT patients have found difficulties to sustain an appropriate home care regimen and referrals. IF patients did not have increased mortality, but IT recipients did, with similar results to those reported for other solid organs.
ABSTRACT
Purpose: We aim to describe the trends in intestinal and multivisceral transplant waiting list activity and outcomes before and after the COVID-19 pandemic. Methods: We used the cohort of intestinal and multivisceral transplant candidates who were on the waiting list November 1, 2020 - June 12, 2020 as recorded in the UNOS STAR files pulled on June 12, 2020. March 1, 2020 was considered “post- COVID.” We used the INTESTINE-WLHISTORY-DATA file to evaluate the frequency of waitlist additions, modifications, and removals over time. Monthly regional Expected events were calculated using the average monthly number of events February 2019-February 2020, and compared to monthly regional Observed events during March 2020-May 2020 Results: In the four months pre-COVID, 193 changes were made to the intestine waiting list, compared with 257 post-COVID. One center reported a dramatic increase in waiting list activity in May 2020, with high activation & inactivation of candidates. All other centers combined exhibited a decrease in intestinal transplant waitlist additions and activations post-COVID. Observed:Expected ratios (O:E) for waitlist activity and transplants stratified by intestine-only and multivisceral candidates are shown in Figure 1. Regions 6 and 7 had no recorded multivisceral waiting list additions, removals, or modifications after March 1, 2020. After March 1, 2020, most regions performed fewer transplants, with a minority increasing their monthly transplant volume. National monthly transplant rates remained stable. Figure 2. There were very few waiting list deaths, with only two recorded post-COVID. Conclusions: Though most regions reduced intestinal and multivisceral transplant volumes after March 1, 2020, national transplant rates remained stable demonstrating significant regional variation in COVID-19 effect on practice.
ABSTRACT
Introduction: On January 30, 2020 the World Health Organization (WHO) declared the 2019-CoV outbreak in China as a global public health emergency and subsequently, a pandemic on March 11th. It was considered that intestinal failure and intestinal transplant patients might have a higher risk of severe complications from the COVID-19 disease, multidisciplinary intestinal failure teams had to adapt their clinical approaches in order to keep this vulnerable group of patients as safe as possible during the pandemic;but data was lacking. Therefore, in order to improve our knowledge, we designed a voluntary, international survey aiming to address the impact of the COVID-19 disease in intestinal failure and transplant patients worldwide. Patient and Methods: A retrospective, observational, multicenter survey was sent to all centers registered at the Intestinal Rehabilitation and Transplant Association (IRTA). The survey contained three modules: the 1st one consisted of 14 questions about the hospital's activity during the COVID-19 pandemic. The 2nd one, contained 43 questions, was about intestinal failure patient management and outcome and the 3rd one (52 questions) focused on intestinal transplant patients. We used the Google Form platform. We aim to present the preliminary results of the first module. Statistical analysis was performed with the IBM SPSS Statistic version 25.0® program. Results: 13/42 (41%) centers responded;including centers from France, Netherlands, Italy, United States, UK, Sweden, Germany and Argentina. Only 2 centers reported moratorium on intestinal (IT) or multivisceral transplant (MVT), with a mean of 3 months (±4) [Table 1]. Since the pandemic started, 2 institutions reported 4 patients with intestinal rehabilitation or on TPN diagnosed with COVID-19 while 7 centers hospitals claimed to have had 9 patients post-IT/MTV affected by the disease. While 7 centers had their routine follow up and 'protocol biopsies' in the post-IT/MTV affected, none reported higher rates of rejection or complications. At the same time, 8 centers (77%) were affected by a mean of 15% decrease in referrals for new evaluations of intestinal failure or transplantation (compared to 2019) [Figure 1]. All centers adapted to utilizing telemedicine to follow up on IT/MVT patients Conclusions: Many aspects of healthcare have been impacted by the COVID-19 pandemic. The survey showed that the number of affected patients has been lower than expected, the reduced number of centers required transient moratorium of their activity, but a secondary observation was that despite the availability of telemedicine, and probably related to the lockdown, there has been a significant reduction in the referrals for evaluation of intestinal failure and transplant patients, that may have the deleterious effect of the delay of treatment in health care system.