key: cord-0762769-31bo5wa7
authors: Nikoupour, Hamed; Arasteh, Peyman; Nikeghbalian, Saman
title: Intestinal transplantation during COVID‐19 pandemic
date: 2020-06-26
journal: Transpl Int
DOI: 10.1111/tri.13684
sha: 4bbe36a2ec85f2ec9d282e084ead8c2760e54aa3
doc_id: 762769
cord_uid: 31bo5wa7

With the wide spread of the COVID‐19 in the world, all activities related to health care have been affected and this includes transplantation surgeries (1). Considering the high transmission rate of the virus and limitations in resources such as intensive care unit (ICU) beds and blood products, in many countries living donor transplantations and pancreas transplantation have been delayed to after the diseases has subsided.

With the wide spread of the COVID-19 in the world, all activities related to health care have been affected and this includes transplantation surgeries (1) . Considering the high transmission rate of the virus and limitations in resources such as intensive care unit (ICU) beds and blood products, in many countries living donor transplantations and pancreas transplantation have been delayed to after the diseases has subsided. More often only deceased donor transplantation for patients with fulminant liver failure and those with high model for end-stage liver disease (MELD) scores are done.

A subject which has been overshadowed by the pandemic and is up for much debate is intestinal transplantations. In countries with home parenteral nutrition (HPN), the continuation of parenteral nutrition (PN) is done in patients' homes and patients only refer to the hospital when an appropriate organ is found for transplantations. However, in many Latin American countries and almost all the countries in the Middle East, facilities for HPN do not exist (2, 3) . As a result, if autonomy of the gastrointestinal system is not restored using autologous gastrointestinal reconstruction surgery (AGIR), these individuals will require hospital admission to receive PN. This is especially important among patients with ultra-short bowels which is the most common indication for intestinal transplantation among adults and is mainly caused by mesenteric ischemia, and in patients with chronic intestinal pseudo-obstruction (CIPO) in whom despite having a trifecta (pyloroplasty + total colectomy + chimney ileostomy) operation the disease has progressed and the patient has become PN dependent. Hospital admission for PN will require patients to be hospitalized for long periods of times and aside to the complications which may occur due to PN itself, these individuals will be highly susceptible to COVID-19. Thus, in these regions, intestinal transplantation should be considered an From another perspective the induction dose of immunosuppressive medication and the serum-level maintenance dose of some immunosuppressive medication (such as tacrolimus) among patients receiving intestinal transplantations is higher compared to other organ transplantation (4), thus more restrictions with regard to contact with other individuals and more strict safety protocols for COVID-19 should be applied for these patients during hospital care and after discharge from the hospital.

As for countries with HPN, considering that patients with organ transplantations seem to have higher rates of mortality compared to the normal population after contracting the novel corona virus (5, 6), although data on COVID-19 and intestinal transplantation are still missing, these countries would benefit from continuation of HPN for patients with intestinal failure.

In conclusion the COVID-19 pandemic has created special circumstances for individuals with intestinal failure in countries without facilities for HPN and this should be an alert to health care officials in these countries to pursue and establish HPN.

World Health Organization, Coronavirus disease (COVID-2019) situation reports 2020

Management of intestinal failure in middle-income countries, for children and adults

A detailed analysis of the current status of intestinal transplantation in the middle east. Current Opinion in Organ Transplantation

Induction immunosuppression with thymoglobulin and rituximab in intestinal and multivisceral transplantation

Covid-19 and kidney transplantation

COVID-19 in solid organ transplant recipients: a single-center case series from Spain