Patients with comorbid condition are known to be at high risk of severe forms of Covid-19. It is highly probable that immunocompromised patients like solid organ transplant (SOT) recipients are also at risk of severe forms of Covid-19. For this purpose, the investigators conducted a nationwide multicentric and multiorgan Registry to collect data about all French SOT recipients who develop a SARS-CoV-2 infection. The aim is to describe the clinical, biological and virological characteristics of these patients and to give information about evolution and prognosis of this particular population. https://clinicaltrials.gov/ct2/show/NCT04360707

This guideline covers children, young people and adults who need or who have had a kidney transplant, and people who are donating a kidney (live donors). It also advises transplant and referring centres on how to run their services, while keeping them safe for patients, donors and staff during the COVID‑19 pandemic. Kidney transplants improve life expectancy and quality of life, and cost less than dialysis in the long term, so providing effective and safe services will benefit patients and make the best use of resources. This guideline is for: - health and care practitioners - health and care staff involved in planning and delivering services - commissioners The recommendations bring together: - existing national and international guidance and policies - advice from specialists working in the NHS from across the UK. These include people with expertise and experience of treating patients for the specific health conditions covered by the guidance during the current COVID‑19 pandemic. NICE guideline [NG178] https://www.nice.org.uk/guidance/NG178

History of heart transplantation in combination with immunosuppressive therapy and acute viral respiratory infection overlay makes the patient difficult to manage In case of COVID-19, the setting is complicated by unknown pathogenesis, including its effect on blood, coagulation system, and lung tissue Current case report discusses the 60-year-old patient with a COVID-19 infection occurred in the immediate postoperative period after heart transplantation Copyright © 2020, Silicea-Poligraf All rights reserved

Management of patients on dialysis or with a kidney transplant during COVID-19 infection. By the Brescia Renal COVID-19 Task Force. https://www.era-edta.org/en/wp-content/uploads/2020/03/COVID_guidelines_finale_eng-GB.pdf

The novel coronavirus, SARS-CoV-2, is causing a pandemic of unknown precedent, with huge healthcare challenges and worldwide disruptions to economic and social life Lung transplant recipients and other solid organ transplant (SOT) recipients are immunosuppressed, and therefore are generally considered at an increased risk for severe infections Given the current gap in knowledge and evidence regarding the best management of these patients, we conducted a systematic review of studies on SARS-CoV-2 infections and Coronavirus Disease 2019 (COVID-19) in SOT recipients, to evaluate the association between immunosuppression in these patients, SARS-CoV-2 infection and COVID-19 outcomes The focus was the severity of the disease, the need for mechanical ventilation and intensive care unit (ICU) admissions, and rate of death The literature search was conducted repeatedly between 16 March and 8 April 2020 We searched original papers, observational studies, case reports, and meta-analyses published between 2019 and 2020 using two databases (PubMed, Google Scholar) with the search terms: [transplant OR immunosuppression] AND [COVID-19 OR SARS-CoV-2] Further inclusion criteria were publications in English, French, German and Italian, and reference to humans We also searched the reference lists of the studies encountered From an initial search of PubMed and Google Scholar, 19 potential articles were retrieved, of which 14 were excluded after full-text screening (not being case reports or case series), leaving 5 studies for inclusion No further studies were identified from the bibliographies of retrieved articles Based on the limited research, no firm conclusions can be made concerning SOT recipients, but the current evidence suggests that immunosuppression is most likely associated with a better outcome of SARS-CoV-2 infection and COVID-19 because it prevents hyperinflammation (cytokine storm) in this particular population There is a need for further research that would allow results to be adjusted for other factors potentially impacting COVID-19 severity and outcome

COVID-19 (novel coronavirus-induced disease) was declared a global pandemic by the WHO on 11th March 2020. Currently there are no drugs proven to treat or delay progression of COVID-19 and no vaccine is yet available. Efforts are underway to repurpose established drugs with well understood drug interactions and safety profiles. Vulnerable populations such as those receiving in-centre dialysis are largely excluded from ongoing trials. The PROTECT Basket clinical trial aims to enrol patients at particularly high risk of COVID-19 and its complications, seeking to test treatments that either might prevent the disease from occurring or may reduce the number of cases where the disease becomes serious or life-threatening. The PROTECT trial will use innovative design and analysis methodologies to allow the simultaneous assessment of one or more treatments in multiple populations. Patients will be eligible for recruitment to the trial if they fall within one of the following vulnerable populations: a) patients receiving in-centre haemodialysis, b) transplant patients, c) vasculitis, or d) other disease groups that may be added during the course of this trial. PROTECT will use an innovate basket design to carry out a series of individually powered prospective, randomised comparisons in distinct vulnerable patient groups in the UK while applying Bayesian approaches to conduct pooled assessment of efficacy. Once consented, eligible participants will be randomised to active treatment or control, stratified by PROTECT subpopulation (disease specific). Enrolment to the trial will be via an online platform and following informed consent subsequent assessments will be done via email or telephone thus reducing the burden to participants as well as reducing their exposure to COVID-19. The master PROTECT protocol describes core components that are shared between disease specific appendices to the core protocol. https://clinicaltrials.gov/ct2/show/NCT04389359

The recent outbreak of the novel virus Severe Acute Respiratory Syndrome Coronavirus‐2 (SARS‐CoV‐2) which causes COVID19 disease has spread globally affecting millions of people. This pandemic has taxed our healthcare system and disrupted normal operations, even of lifesaving procedures like liver transplants. During these unprecedented times providers and patients are imperiled and resources for diagnosis and care may be limited. Continuing to perform resource intense advanced procedures is challenging, as is caring for patients with end‐stage liver disease or patients with urgent needs for liver tumor control. Liver transplantation in particular requires critical resources like blood products and critical care beds, which are fairly limited in the COVID19 pandemic. The potential of COVID19 infections in post‐transplant patients on immunosuppression and staff contacts further adds to the complexity. Therefore, transplant programs must re‐evaluate the ethicality, feasibility, and safety of performing liver transplants during this pandemic. Herein, we discuss the clinical and ethical challenges posed by performing liver transplants and offer guidance for managing patients with end‐stage liver disease during the COVID19 pandemic.

COVID-19 is a global major public health emergency that disproportionately affects patients with risk factors such as advanced age, heart and lung disease, diabetes, hypertension, as well as compromised immunity. Despite the recent worldwide emergence of this disease and its rapid progression to a pandemic, very little is known about the risks facing solid organ recipients. The study aims to elucidate the prevalence of symptomatic, subclinical, and asymptomatic infection in the transplanted population by assessing their immunological response to SARS-CoV-2 infection. This will be studied seroepidemiologically in the whole cohort and retrospectively in transplanted patients admitted to hospital for COVID-19. Primary objective: to elucidate the cumulative prevalence of SARS-CoV-2 infection in the transplanted population related to symptoms and hospitalizations; to assess the magnitude of immunological response and seroconversion kinetics for COVID-19. Secondary objectives: To examine the influence of medical parameters on COVID-19 infection and immune response such as: age, comorbidities current and recent pharmacological treatment, organ transplanted, and blood type, HLA genotype. Study design: Part 1: Longitudinal cohort study for seroepidemiology and disease burden. Part 2: Retrospective case-series for seroconversion kinetics and clinical course assessment. Study population: All solid organ transplanted patients in the Transplant Institute, Sahlgrenska University hospital, catchment area. https://clinicaltrials.gov/show/NCT04407221

On March 12, a meeting of the Organ Donation and Transplantation Expert Advisory Committee (ODTEAC) brought together donation and transplantation leaders from across the country. The aim of the meeting was to develop consensus guidance that can be used by provincial organ donation organizations and regional transplant and donation programs to guide the administration of organ and tissue donation and transplantation services in light of the COVID-19 pandemic. It is understood that each organization, program and jurisdiction will develop their own policies. Because the situation is rapidly evolving, a teleconference will be held at least once a week to discuss and update the consensus guidance. Consensus guidance for organ donation and transplantation services during COVID-19 will continue to be informed by recommendations from Canadian Blood Services’ advisory committees, Health Canada, Public Health Agency of Canada, WHO, provincial agencies, and international partners (including UK and Spain). https://profedu.blood.ca/sites/msi/files/20200409_covid-19_consensus_guidance_final_0.pdf