@article{e271d9a7b81849bd997317f20d0de97a,
title = "Operational challenges in the COVID-19 era: Asymptomatic infections and vaccination timing",
abstract = "The coronavirus disease 2019 (COVID-19) pandemic has created unprecedented challenges for solid organ transplant programs. While transplant activity has largely recovered, appropriate management of deceased donor candidates who are asymptomatic but have positive nucleic acid testing (NAT) for SARS-CoV-2 is unclear, as this result may reflect active infection or prolonged viral shedding. Furthermore, candidates who are unvaccinated or partially vaccinated continue to receive donor offers. In the absence of robust outcomes data, transplant professionals at US adult kidney transplant centers were surveyed (February 13, 2021 to April 29, 2021) to determine community practice (N: 92 centers, capturing 41% of centers and 57% of transplants performed). The majority (97%) of responding centers declined organs for asymptomatic NAT+ patients without documented prior infection. However, 32% of centers proceed with kidney transplant in NAT+ patients who were at least 30 days from initial diagnosis with negative chest imaging. Less than 7% of programs reported inactivating patients who were unvaccinated or partially vaccinated. In conclusion, despite national recommendations to wait for negative testing, many centers are proceeding with kidney transplant in patients with positive SARS-CoV-2 NAT results due to presumed viral shedding. Furthermore, few centers are requiring COVID-19 vaccination prior to transplantation at this time.",
keywords = "COVID-19, kidney transplantation, offer acceptance, pandemic, practices, vaccination, waitlist management",
author = "Axelrod, {David A.} and Dilek Ince and Harhay, {Meera N.} and Mannon, {Roslyn B.} and Tarek Alhamad and Matthew Cooper and Josephson, {Michelle A.} and Yasar Caliskan and Asif Sharfuddin and Vineeta Kumar and Alexis Guenette and Schnitzler, {Mark A.} and Sruthi Ainapurapu and Lentine, {Krista L.}",
note = "Funding Information: The authors thank survey respondents, including members of the American Society of Transplantation (AST) Kidney Pancreas Community of Practice (COP), Infectious Disease COP, and Outstanding Questions in Transplantation list servs, and the AST Education Committee and ASTS Council for review of the survey instrument. Distribution to American Society of Transplant (ASTS) members was conducted with an approved Data Use Agreement. We also thank Saint Louis University Biostatisticians Ruixin Li, MS and Huiling Xiao, MS, for manuscript preparation support. Krista L. Lentine is supported by the Mid-America Transplant/Jane A. Beckman Endowed Chair in Transplantation and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01DK120551. Funding Information: The authors thank survey respondents, including members of the American Society of Transplantation (AST) Kidney Pancreas Community of Practice (COP), Infectious Disease COP, and Outstanding Questions in Transplantation list servs, and the AST Education Committee and ASTS Council for review of the survey instrument. Distribution to American Society of Transplant (ASTS) members was conducted with an approved Data Use Agreement. We also thank Saint Louis University Biostatisticians Ruixin Li, MS and Huiling Xiao, MS, for manuscript preparation support. Krista L. Lentine is supported by the Mid‐America Transplant/Jane A. Beckman Endowed Chair in Transplantation and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01DK120551. Publisher Copyright: {\textcopyright} 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.",
year = "2021",
month = nov,
doi = "10.1111/ctr.14437",
language = "English (US)",
volume = "35",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley",
number = "11",
}