key: cord-0777184-wd4ctrb3
authors: Picard, C; Le Pavec, J; Tissot, A
title: Impact of the Covid-19 Pandemic and Lung Transplantation Program in France
date: 2020-05-08
journal: Respir Med Res
DOI: 10.1016/j.resmer.2020.100758
sha: b81378dee2c655756b235b33403cdce4cbd327a5
doc_id: 777184
cord_uid: wd4ctrb3

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J o u r n a l P r e -p r o o f

Key words (anglais, MesH) show a high level of concern for their health, which may result in their applying protective measures more rigorously than the general population. LT recipients usually attend regular outpatient clinic assessments to monitor lung function and the immunosuppressant regimen. Since the confinement decree, follow-up has been provided by telemedicine from one day to another. The lessons taught by this monitoring method will help to settle the long-standing debate about whether frequent outpatient clinic visits are necessary. Home spirometry is, of course, a crucial component of remote patient monitoring. Fear of contracting the virus has produced several unwanted behaviours among LT patients, such as failure to monitor the immunosuppressant levels or failure to attend hospital appointments that are sometimes needed to manage complications. We will need to monitor these indirect effects of the pandemic on our highly vulnerable patients. Moreover, inappropriate behaviours have also been noted among physicians. Rumours fuelled by the media that many drugs had beneficial effects on the disease resulted in massive numbers of prescriptions that have depleted the stocks of some drugs. Macrolides are an example. Azithomycin is taken by over half of all LT recipients to treat chronic allograft dysfunction (CLAD) according to guidelines (3) . As CLAD is the leading cause of mortality in LT recipients, its unavailability is clearly a cause of concern.

Finally, the impact of the pandemic on the economic resources available to our healthcare service is of great concern. LT programs are costly in terms of time, equipment, and human resources and they J o u r n a l P r e -p r o o f are consequently available only in wealthy countries. We will need to develop policies that make LT available to all candidates. Health professionals will have to maintain a high level of alertness regarding the need for equity.

We will learn many lessons from this catastrophe that is challenging the robustness of the complex organisation of LT programs. First, we will have to continue to explain LT to our colleagues (both physician and other healthcare professionals) to maintain a high degree of awareness of this time consuming and emotionally challenging procedure. Second, LT organisation at the national level should in the future consider an alternative organization in order to preserve the access to LT in times of crisis.

Third, priority access should be put in place for major drugs such as azithromycin, immunosuppressants, and antibiotics required by specific populations of patients with chronic diseases. Fourth, although telemedicine tools and, artificial intelligence will no doubt change the way we interact with patients, we must remain alert to the limitations of these methods as compared to in-person visits. This pandemic is an opportunity to learn. We must evaluate, understand and move quickly to keep our programs efficient for the future.

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