The COVID‐19 pandemic has rapidly evolved and changed our way of life in an unprecedented manner. The emergence of COVID‐19 has impacted transplantation worldwide. The impact has not been just ...restricted to issues pertaining to donors or recipients, but also health‐care resource utilization as the intensity of cases in certain jurisdictions exceeds available capacity. Here we provide a personal viewpoint representing different jurisdictions from around the world in order to outline the impact of the current COVID‐19 pandemic on organ transplantation. Based on our collective experience, we discuss mitigation strategies such as donor screening, resource planning, and a staged approach to transplant volume considerations as local resource issues demand. We also discuss issues related to transplant‐related research during the pandemic, the role of transplant infectious diseases, and the influence of transplant societies for education and disseminating current information.
The authors discuss the impact of COVID‐19 on donation and transplantation and provide a global framework for donor screening and management of transplant activity during the pandemic.
Impact of COVID‐19 in solid organ transplant recipients Danziger‐Isakov, Lara; Blumberg, Emily A.; Manuel, Oriol ...
American journal of transplantation,
March 2021, 2021-03-00, 20210301, Letnik:
21, Številka:
3
Journal Article
Recenzirano
Odprti dostop
The coronavirus disease 2019 (COVID‐19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) exploded onto the world stage in early 2020. The impact on solid organ ...transplantation (SOT) has been profound affecting potential donors, candidates, and recipients. Importantly, decreased donations and the pressure of limited resources placed on health care by the pandemic also disrupted transplant systems. We address the impact of COVID‐19 on organ transplantation globally and review current understanding of the epidemiology, outcomes, diagnosis, and treatment of COVID‐19 in SOT recipients.
The authors address the global impact of COVID‐19 on organ transplantation and the current understanding of the epidemiology, outcomes, diagnosis, and treatment of COVID‐19 in solid organ transplant recipients.
The use of vaccines with higher doses of antigen is an attractive strategy to improve the immunogenicity of influenza vaccination in transplant recipients. However, the effect of vaccination with a ...double-dose (DD) containing 30 µg of antigen in this population remains unknown.
We performed a randomized controlled trial to compare the immunogenicity and safety of DD (30 µg) vs. standard dose (SD, 15 µg) of a trivalent inactivated influenza vaccine in kidney and liver transplant recipients. Immunogenicity was assessed by hemagglutination-inhibition assay. Vaccine response was defined as seroconversion to at least one viral strain 2 weeks after vaccination and seroprotection as a titer ≥40.
Sixty-three kidney and 16 liver transplant recipients were enrolled. Forty patients received the DD and 39 the SD vaccine. Overall, 40% of patients in the DD compared to 26% in the SD group (P = 0.174) responded to vaccine. In the DD arm, more patients were seroprotected to all viral strains after vaccination (88% vs 69%, P = 0.048). Post vaccination geometric mean titers of antibodies were 131.9 vs. 89.7 (P = 0.187) for H1N1, 185.4 vs. 138.7 (P = 0.182) for H3N2, and 96.6 vs. 68.8 (P = 0.081) for influenza B with the DD vs. SD. In both groups, most of the adverse events were mild and no vaccine-related severe adverse events were observed.
Double-dose influenza vaccine is safe and may increase antibody response in transplant recipients. In this population, DD vaccination could be an alternative when high-dose vaccine is not available. NCT02746783.
Si bien es cierto que el problema filosófico del mal no es uno de los temas centrales de la filosofía griega clásica, podemos encontrar en ella agudas reflexiones sobre el mismo. El primer objetivo ...de este trabajo es examinar la problemática del mal moral en Aristóteles, específicamente en la Ética a Nicómaco. Para ello, nos aproximaremos al planteamiento general de la ética aristotélica y al papel que en ella juega el estudio del vicio frente al de la virtud, así como de otras disposiciones morales. A continuación, se distinguirán los diferentes caracteres morales que pueden calificarse de malos (vicio, akrasía y bestialidad), haciendo un breve resumen de sus principales características. El segundo objetivo es comparar el concepto cristiano de pecado y el tratamiento aristotélico del mal moral. Comenzaremos remarcando las similitudes, para después encontrar algunas diferencias esenciales, atendiendo a la trascendencia, el alcance, la responsabilidad y la superación del mal moral.
Introduction
Antimicrobial stewardship programs (ASPs) are essential for minimizing the emergence of antimicrobial resistance, while improving patient outcomes. The current status of ASP in the field ...of organ transplantation in Switzerland has not been well characterized.
Methods
We describe in this article the current status of ASP and discuss challenges and opportunities of implementing ASP dedicated to solid‐organ transplant (SOT) recipients in Switzerland.
Results
ASP have been implemented in the Swiss healthcare system over the last years, although specific strategies for SOT recipients are mostly based on transplant infectious diseases (TID) consultations rather than structured institutional interventions. Even so, there is a unique opportunity for developing a successful ASP in Switzerland that also specifically addresses areas of practice relevant to SOT recipients. This is due to the existent network of TID specialists in close collaboration with transplant physicians, the small number of centers involved in the care of transplant recipients, and the development of the Swiss Transplant Cohort Study (STCS), a prospective nationwide cohort of SOT recipients in Switzerland. The STCS can identify actual challenges through the updated reports on the epidemiology on transplant infections, accurately monitor the impact of potential antimicrobial stewardship interventions, and represent an opportunity for nesting of pragmatic randomized controlled trials to address key questions about optimized antibiotic use for SOT recipients.
Conclusions
Although ASP in SOT recipients rely more on specific TID consultations than in general antimicrobial stewardship teams, we identified several opportunities for the implementation of a successful ASP in Switzerland.
Graphical :
Summary
In response to the COVID‐19 pandemic, SARS‐CoV‐2 vaccines have been developed at an unparalleled speed, with 14 SARS‐CoV‐2 vaccines currently authorized. Solid‐organ transplant (SOT) ...recipients are at risk for developing a higher rate of COVID‐19‐related complications and therefore they are at priority for immunization against SARS‐CoV‐2. Preliminary data suggest that although SARS‐CoV‐2 vaccines are safe in SOT recipients (with similar rate of adverse events than in the general population), the antibody responses are decreased in this population. Risk factors for poor vaccine immunogenicity include older age, shorter time from transplantation, use of mycophenolate and belatacept, and worse allograft function. SOT recipients should continue to be advised to maintain hand hygiene, use of facemasks, and social distancing after SARS‐CoV‐2 vaccine. Vaccination of household contacts should be also prioritized. Although highly encouraged for research purposes, systematic assessment in clinical practice of humoral and cellular immune responses after SARS‐CoV‐2 vaccination is controversial, since correlation between immunological findings and clinical protection from severe COVID‐19, and cutoffs for protection are currently unknown in SOT recipients. Alternative immunization schemes, including a booster dose, higher doses, and modulation of immunosuppression during vaccination, need to be assessed in the context of well‐designed clinical trials.
In this review, we summarize the existent literature of the low immunogenicity of SARS‐CoV‐2 vaccines in SOT recipients. We discuss the clinical relevance of this observation, the strategies that may potentially increase the immune response of the vaccine, and the information that we should convey to transplant physicians and patients.
This study aims to describe the epidemiology of COVID-19 patients in a Swiss university hospital.
This retrospective observational study included all adult patients hospitalized with a laboratory ...confirmed SARS-CoV-2 infection from March 1 to March 25, 2020. We extracted data from electronic health records. The primary outcome was the need to mechanical ventilation at day 14. We used multivariate logistic regression to identify risk factors for mechanical ventilation. Follow-up was of at least 14 days.
145 patients were included in the multivariate model, of whom 36 (24.8%) needed mechanical ventilation at 14 days. The median time from symptoms onset to mechanical ventilation was 9·5 days (IQR 7.00, 12.75). Multivariable regression showed increased odds of mechanical ventilation with age (OR 1.09 per year, 95% CI 1.03-1.16, p = 0.002), in males (OR 6.99, 95% CI 1.68-29.03, p = 0.007), in patients who presented with a qSOFA score ≥2 (OR 7.24, 95% CI 1.64-32.03, p = 0.009), with bilateral infiltrate (OR 18.92, 3.94-98.23, p<0.001) or with a CRP of 40 mg/l or greater (OR 5.44, 1.18-25.25; p = 0.030) on admission. Patients with more than seven days of symptoms on admission had decreased odds of mechanical ventilation (0.087, 95% CI 0.02-0.38, p = 0.001).
This study gives some insight in the epidemiology and clinical course of patients admitted in a European tertiary hospital with SARS-CoV-2 infection. Age, male sex, high qSOFA score, CRP of 40 mg/l or greater and a bilateral radiological infiltrate could help clinicians identify patients at high risk for mechanical ventilation.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Biological therapies have improved the outcomes of several major inflammatory, autoimmune and also neoplastic disorders. Those directed towards cytokines or other soluble mediators, cell-surface ...molecules or receptors or various components of intracellular signalling pathways may be associated with the occurrence of infections whose diversity depends on the particular immune target. In this context and following a keynote lecture given by one of us at the European League Against Rheumatism meeting on June 2018, a multidisciplinary group of experts deeply involved in the use of targeted and biological therapies in rheumatoid and psoriatic arthritis decided to summarise their recent vision of the immunological basis and epidemiology of infections occurring during targeted and biological therapies, and provide useful indications for their management and prevention.
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