key: cord-1050260-cybiznxp authors: Agnes, Salvatore; Andorno, Enzo; Avolio, Alfonso W; Baccarani, Umberto; Carraro, Amedeo; Cescon, Matteo; Cillo, Umberto; Colledan, Michele; De Carlis, Luciano; De Simone, Paolo; De Ville De Goyet, Jean; Di Benedetto, Fabrizio; Ettorre, Giuseppe M; Gringeri, Enrico; Gruttadauria, Salvatore; Lupo, Luigi G; Mazzaferro, Vincenzo; Regalia, Enrico; Romagnoli, Renato; Rossi, Giorgio E; Rossi, Massimo; Spada, Marco; Tisone, Giuseppe; Vennarecci, Giovanni; Vivarelli, Marco; Zamboni, Fausto; Boggi, Ugo title: Preliminary Analysis of the Impact of COVID‐19 Outbreak on Italian Liver Transplant Programs date: 2020-05-06 journal: Liver Transpl DOI: 10.1002/lt.25790 sha: 005ee8f68c1e67e2ca954e9241cd2947c1a42533 doc_id: 1050260 cord_uid: cybiznxp Liver Transplant Programs in Italy have faced a sequela of management and clinical decision‐making problems due to the high incidence in some regions of the country of severe acute respiratory syndrome Coronavirus 2 (SARS‐CoV‐2). The Italian Society for Organ Transplantation (SITO) and the Board of Liver Transplant Program Directors issued a survey to assess the initial impact of this pandemic event on the routine activity of 22 Italian Liver Transplant Programs. One hundred percent of participants completed the survey within a few days. The analysis is presented dividing the centers in two macro‐areas: north‐central Italy and south‐central Italy. The reason for this is that the two areas had a different incidence of the infection and because they have distinctive rates of cadaveric donation. Overall, all centers remained open although a reduction in the activity was noted. Transplant Programs reduced their outpatient activity both in terms of pre‐transplant evaluation (68% of the centers) and transplant recipient follow‐up (100%); a reduction in transplant activity was observed in the first two weeks of March only in the north‐central macro area (23 LTs vs 39 in 2018 and 60 in 2019); overall, SARS‐CoV‐2 infection was registered for 24 liver transplant recipients and 37 health care providers in liver transplant units. In the perspective of the increasing magnitude of the epidemic, more data will be required to define appropriate strategies for the increasingly complex management of liver transplant patients. We hereby certify that all the authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. The authors of this manuscript have no competing interest to disclose as described by Liver Transplantation. Not applicable. Our manuscript does not report on, or involve the use of any animal or human data or tissue, and does not contain data from any individual person, so this section is not applicable to our submission. Not applicable. Our manuscript does not contain data from any individual person, so this section is not applicable to our submission. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. The results of the survey are summarized in Table 1 . The analysis is presented dividing all centers into two macro-areas: north-central Italy and southcentral Italy. The reason for this is that the two areas had a different incidence of the infection and However, in the perspective of the exponentially increasing magnitude of the epidemic (Figure 1a ), other problems remain and more time will be required to appropriately manage them. A more detailed analysis will be performed shortly adding data of the second half of March and April, when the peak of the infection is expected. An increasingly complex management of sick patients waiting for an organ and an elevated risk of drop out and mortality on the waiting list are the two major concerns of the Italian Liver Transplant community. With the commitment of intensive care units to primarily provide care to COVID-19 patients, the rate of deceased donations is not expected to improve in the short term. In addition, the wrong perception of more stable clinical individuals on the waiting list, such as oncologic patients, may be the reason of some denies reported after a call for a potential transplant. This article is protected by copyright. All rights reserved Priorities include solving logistical problems such as defining safe pathways for transplant patients inside the hospitals, and identifying appropriate strategies to deliver informed consent and all information related the potential increased risk of infection to transplant patients. In conclusion, while we are optimistic on the overall approach of the Italian Liver Transplant community to this violent outbreak, we are aware that additional critical data analysis and work are required to continue ensuring a lifesaving procedure such as Liver Transplant to many sick patients. This article is protected by copyright. All rights reserved Supplementary Table S1. . This article is protected by copyright. All rights reserved Covid-19 -Navigating the Uncharted Coronaviruses and immunosuppressed patients. The facts during the third epidemic Coronavirus Disease 2019 and Transplantation: a view from the inside 28 Febbraio Critical Care Utilization for the COVID-19 Outbreak in Early Experience and Forecast During an Emergency Response This article is protected by copyright. All rights reserved This article is protected by copyright. All rights reserved