• Transplant immunology · Aug 2020

    Editorial

    Immediate impact of COVID-19 on transplant activity in the Netherlands.

    • A P J de Vries, I P J Alwayn, R A S Hoek, A P van den Berg, F C W Ultee, S M Vogelaar, Haase-Kromwijk B J J M BJJM Dutch Transplant Foundation (DTF/NTS), Leiden, the Netherlands., M B A Heemskerk, A C Hemke, W N Nijboer, B S Schaefer, M A Kuiper, J de Jonge, N P van der Kaaij, and M E J Reinders.
    • Department of Internal Medicine, Division of Nephrology and Transplant Center, Leiden University Medical Center, Leiden, the Netherlands.
    • Transpl. Immunol. 2020 Aug 1; 61: 101304.

    AbstractThe rapid emergence of the COVID-19 pandemic is unprecedented and poses an unparalleled obstacle in the sixty-five year history of organ transplantation. Worldwide, the delivery of transplant care is severely challenged by matters concerning - but not limited to - organ procurement, risk of SARS-CoV-2 transmission, screening strategies of donors and recipients, decisions to postpone or proceed with transplantation, the attributable risk of immunosuppression for COVID-19 and entrenched health care resources and capacity. The transplant community is faced with choosing a lesser of two evils: initiating immunosuppression and potentially accepting detrimental outcome when transplant recipients develop COVID-19 versus postponing transplantation and accepting associated waitlist mortality. Notably, prioritization of health care services for COVID-19 care raises concerns about allocation of resources to deliver care for transplant patients who might otherwise have excellent 1-year and 10-year survival rates. Children and young adults with end-stage organ disease in particular seem more disadvantaged by withholding transplantation because of capacity issues than from medical consequences of SARS-CoV-2. This report details the nationwide response of the Dutch transplant community to these issues and the immediate consequences for transplant activity. Worrisome, there was a significant decrease in organ donation numbers affecting all organ transplant services. In addition, there was a detrimental effect on transplantation numbers in children with end-organ failure. Ongoing efforts focus on mitigation of not only primary but also secondary harm of the pandemic and to find right definitions and momentum to restore the transplant programs.Copyright © 2020 Elsevier B.V. All rights reserved.

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