Beatrice Tazza , Natascia Caroccia , Alice Toschi , Renato Pascale , Effrosyni Gkrania-Klotsas , Paula Olivares Navarro , Lorenzo Maria Canziani , Alessandro Tavelli , Andrea Antinori , Paolo Antonio Grossi , Maddalena Peghin , Evelina Tacconelli , Zaira Raquel Palacios-Baena , Pierluigi Viale , Maddalena Giannella
{"title":"实体器官移植受者SARS-CoV-2感染的诊断和治疗管理。","authors":"Beatrice Tazza , Natascia Caroccia , Alice Toschi , Renato Pascale , Effrosyni Gkrania-Klotsas , Paula Olivares Navarro , Lorenzo Maria Canziani , Alessandro Tavelli , Andrea Antinori , Paolo Antonio Grossi , Maddalena Peghin , Evelina Tacconelli , Zaira Raquel Palacios-Baena , Pierluigi Viale , Maddalena Giannella","doi":"10.1016/j.cmi.2025.02.010","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to address existing knowledge gaps regarding risk stratification, best use of diagnostic resources, optimal treatment, and general management of SARS-CoV-2 infection in solid organ transplant (SOT) recipients. As high-quality evidence specific to this fragile population is lacking, our final aim was to provide an expert consensus evidence-informed guidance that can aid clinicians in their daily practice.</div></div><div><h3>Methods</h3><div>This study was conducted within the Working Package 4 (fragile population cohorts) of the H2020-funded ORCHESTRA study (<span><span>https://orchestra-cohort.eu</span><svg><path></path></svg></span>). Eight infectious disease and one clinical pharmacology specialists conducted a comprehensive scoping literature review which covered five key areas: the role of SOT as a risk factor for evolution to severe disease; the optimal use of diagnostic resources, considering cost–benefit ratios and appropriateness of active screening; population-specific therapeutic management, including antiviral use and drug–drug interactions and appropriate duration of treatment; the potential need for withdrawal of immunosuppressive agents and management of potential donors and recipients with recent and/or ongoing SARS-CoV-2 infection at the time of transplantation. On the basis of this review, a 28-item questionnaire was developed and administered to a panel of experts through two rounds, following the Delphi methodology.</div></div><div><h3>Results</h3><div>The panel consisted of 21 experts, 13 females and 8 males, from Italy (<em>n</em> = 11), Spain (<em>n</em> = 5), Switzerland (<em>n</em> = 2), Brazil (<em>n</em> = 1), United States (<em>n</em> = 1), and United Kingdom (<em>n</em> = 1). Consensus was achieved for 18 out of 28 items after the first round and for 9 out of 13 items after the second round, according to agreement/disagreement levels obtained for each question and round, ten statements were finally produced.</div></div><div><h3>Discussion</h3><div>The consensus statements derived from this study offer a framework for standardizing care and improving outcomes in SOT recipients affected by SARS-CoV-2 infection in a field where high-quality evidence specific to this high-risk population is currently lacking.</div></div>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":"31 8","pages":"Pages S3-S13"},"PeriodicalIF":8.7000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"ORCHESTRA Delphi consensus: diagnostic and therapeutic management of SARS-CoV-2 infection in solid organ transplant recipients\",\"authors\":\"Beatrice Tazza , Natascia Caroccia , Alice Toschi , Renato Pascale , Effrosyni Gkrania-Klotsas , Paula Olivares Navarro , Lorenzo Maria Canziani , Alessandro Tavelli , Andrea Antinori , Paolo Antonio Grossi , Maddalena Peghin , Evelina Tacconelli , Zaira Raquel Palacios-Baena , Pierluigi Viale , Maddalena Giannella\",\"doi\":\"10.1016/j.cmi.2025.02.010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><div>We aimed to address existing knowledge gaps regarding risk stratification, best use of diagnostic resources, optimal treatment, and general management of SARS-CoV-2 infection in solid organ transplant (SOT) recipients. As high-quality evidence specific to this fragile population is lacking, our final aim was to provide an expert consensus evidence-informed guidance that can aid clinicians in their daily practice.</div></div><div><h3>Methods</h3><div>This study was conducted within the Working Package 4 (fragile population cohorts) of the H2020-funded ORCHESTRA study (<span><span>https://orchestra-cohort.eu</span><svg><path></path></svg></span>). Eight infectious disease and one clinical pharmacology specialists conducted a comprehensive scoping literature review which covered five key areas: the role of SOT as a risk factor for evolution to severe disease; the optimal use of diagnostic resources, considering cost–benefit ratios and appropriateness of active screening; population-specific therapeutic management, including antiviral use and drug–drug interactions and appropriate duration of treatment; the potential need for withdrawal of immunosuppressive agents and management of potential donors and recipients with recent and/or ongoing SARS-CoV-2 infection at the time of transplantation. On the basis of this review, a 28-item questionnaire was developed and administered to a panel of experts through two rounds, following the Delphi methodology.</div></div><div><h3>Results</h3><div>The panel consisted of 21 experts, 13 females and 8 males, from Italy (<em>n</em> = 11), Spain (<em>n</em> = 5), Switzerland (<em>n</em> = 2), Brazil (<em>n</em> = 1), United States (<em>n</em> = 1), and United Kingdom (<em>n</em> = 1). Consensus was achieved for 18 out of 28 items after the first round and for 9 out of 13 items after the second round, according to agreement/disagreement levels obtained for each question and round, ten statements were finally produced.</div></div><div><h3>Discussion</h3><div>The consensus statements derived from this study offer a framework for standardizing care and improving outcomes in SOT recipients affected by SARS-CoV-2 infection in a field where high-quality evidence specific to this high-risk population is currently lacking.</div></div>\",\"PeriodicalId\":10444,\"journal\":{\"name\":\"Clinical Microbiology and Infection\",\"volume\":\"31 8\",\"pages\":\"Pages S3-S13\"},\"PeriodicalIF\":8.7000,\"publicationDate\":\"2025-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Microbiology and Infection\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1198743X25000692\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/2/13 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Microbiology and Infection","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1198743X25000692","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/13 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
ORCHESTRA Delphi consensus: diagnostic and therapeutic management of SARS-CoV-2 infection in solid organ transplant recipients
Objectives
We aimed to address existing knowledge gaps regarding risk stratification, best use of diagnostic resources, optimal treatment, and general management of SARS-CoV-2 infection in solid organ transplant (SOT) recipients. As high-quality evidence specific to this fragile population is lacking, our final aim was to provide an expert consensus evidence-informed guidance that can aid clinicians in their daily practice.
Methods
This study was conducted within the Working Package 4 (fragile population cohorts) of the H2020-funded ORCHESTRA study (https://orchestra-cohort.eu). Eight infectious disease and one clinical pharmacology specialists conducted a comprehensive scoping literature review which covered five key areas: the role of SOT as a risk factor for evolution to severe disease; the optimal use of diagnostic resources, considering cost–benefit ratios and appropriateness of active screening; population-specific therapeutic management, including antiviral use and drug–drug interactions and appropriate duration of treatment; the potential need for withdrawal of immunosuppressive agents and management of potential donors and recipients with recent and/or ongoing SARS-CoV-2 infection at the time of transplantation. On the basis of this review, a 28-item questionnaire was developed and administered to a panel of experts through two rounds, following the Delphi methodology.
Results
The panel consisted of 21 experts, 13 females and 8 males, from Italy (n = 11), Spain (n = 5), Switzerland (n = 2), Brazil (n = 1), United States (n = 1), and United Kingdom (n = 1). Consensus was achieved for 18 out of 28 items after the first round and for 9 out of 13 items after the second round, according to agreement/disagreement levels obtained for each question and round, ten statements were finally produced.
Discussion
The consensus statements derived from this study offer a framework for standardizing care and improving outcomes in SOT recipients affected by SARS-CoV-2 infection in a field where high-quality evidence specific to this high-risk population is currently lacking.
期刊介绍：
Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.
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