key: cord-1039871-v8xri0a0 authors: Pascale, Marco Maria; Bianco, Giuseppe; Ferri, Lorenzo; Agnes, Salvatore title: COVID‐19 health restrictions in a transplanted Italian cohort date: 2020-05-27 journal: Transpl Int DOI: 10.1111/tri.13661 sha: 144efebf2134386bdd34212aae97f9a326e3fd98 doc_id: 1039871 cord_uid: v8xri0a0 An exponential diffusion of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) prompted Italian Institutions to take extraordinary healthcare restrictive measures since 8(th) March 2020, declaring quarantine for COVID‐19 (1). Dear Editors, an exponential diffusion of severe acute respiratory syndrome coronavirus 2 prompted Italian Institutions to take extraordinary healthcare restrictive measures since 8 th March 2020, declaring quarantine for COVID-19 (1). The whole population had to adapt to new limits, which were interestingly in line with the postdischarge indications given to liver recipients (LRs) in our Transplant Center. This article is protected by copyright. All rights reserved The aim of this work was to analyze the tolerance to the health restrictions of LRs, comparing them with the rest of the Italian population. We investigated the compliance of the 96 consecutive LRs discharged between January 2017 and March 2020 from our Center. Then, we created a web-based national survey, spread via social media, in order to create a standard of quarantine compliance involving the non-transplant population from all over Italy with an age ≥18 years ( Figure S1 in the "Supplementary Material"). Furthermore, we performed a subgroup analysis between LRs and the non-transplanted population living in the same regions as LRs (local control group, LCG), in order to decrease bias related to the incidence of COVID-19 across Italy. All data were analysed using chi-square test and student's t-test. We created a survey with 510 participants who gave their informed consent to the survey. In particular, we enrolled 76 LRs and 434 non-transplanted individuals. From the latter population, we obtained the LCG with 202 individuals. LRs' response rate was 79.2%. The response rate of the non-transplant population cannot be calculated due to the way the survey is administered. The LRs were confirmed to be older than the non-transplant population (median age 58 years vs 44.5 years, p<0.001), with more male individuals among LRs than in the non-transplant population (81.6% vs 30.9%, p<.001), in line with the data in the literature (2) (Table 1A) . Social distancing was respected homogeneously in all three time ranges examined (0-14 days, 15-30 days,>30 days), by both the LRs and the non-transplant population; no differences were found also comparing the LRs with the LCG. Indeed, the low rate of SARS-CoV2 swab tests recorded in both the LRs and the non-transplant population (6.6% and 1.8%, respectively), was in favour of a good self-isolating. A continuous use of the personal protective equipment (PPE) was present in 94.7% among LRs, compared to 76% in the non-transplant population (p<0.001) and 73.8% in the LCG (p<0.001). In the subgroup analysis (Table 1B) , among participants respecting a maximum social distancing ≥30 days, the LRs reported a greater constant use of PPE than the non-transplant population (100% vs 78.8%, p=0.02) and the LCG (100% vs 80.6%, p=0.02). This article is protected by copyright. All rights reserved Also, in the subgroup analysis among participants with a maximum social distancing ≤15 days, the continuous use of PPE is higher in LRs (94.3%), than in the non-transplant population (70.6%, p=0.003) and the LCG (66.7%, p=0.001). LRs are a population at high risk of infection (3) . A strict outpatient follow-up and an increased awareness in LRs about prevention measures are fundamental to reduce post-transplant complications (4) . LRs manage to consider health restrictions as a useful instrument, acquiring a fundamental advantage in a pandemic. In our series, LRs prove high levels of tolerance with COVID-19-relate restrictions, partly explaining lower incidence of SARS-CoV-2 infection in transplant population (5) . Our data also confirms the good compliance of the non-transplant population, too. The main limit of this work is the monocentric design with LRs out of the area with the highest COVID-19 incidence. The compliance of the population with the social distancing measures is fundamental to reduce the spread of SARS-CoV-2 (6; 7). The tolerance of a high-risk group can be used as a benchmark. ISS per COVID-19. Istituto Superiore di Sanità Annual Data Report: Liver Infections in liver and lung transplant recipients: a national prospective cohort Accepted Article This article is protected by copyright. All rights reserved Respiratory viruses in transplant recipients: more than just a cold. Clinical syndromes and infection prevention principles First experience of SARS-CoV-2 infections in solid organ transplant recipients in the Swiss Transplant Cohort Study A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster Guide to public health measures to reduce the impact of influenza pandemics in Europe: 'The ECDC Menu'. ECDC The authors of this manuscript have no conflicts of interest to disclose as described by TransplantInternational.