ORCHESTRA Delphi consensus: diagnostic and therapeutic management of SARS-CoV-2 infection in solid organ transplant recipients
- Authors: Tazza, B.; Caroccia, N.; Toschi, A.; Pascale, R.; Gkrania-Klotsas, E.; Navarro, P.O.; Canziani, L.M.; Tavelli, A.; Antinori, A.; Grossi, P.A.; Peghin, M.; Tacconelli, E.; Palacios-Baena, Z.R.; Viale, P.; Giannella, M.; Pierrotti, L.; Manuel, O.; Mularoni, A.; Avery, R.; Paniagua, M.; Bartoletti, M.; Carbone, J.; Valerio, M.; Mueller, N.; Los-Arcos, I.; Bodro, M.; Gkrania-Klotsas, E.; Graziano, E.; Balsamo, M.L.; Rinaldi, M.; Pascale, R.; Bonazzetti, C.; Giannella, M.; Tazza, B.; Grossi, P.; Peghin, M.; Addis, E.; Azzini, A.; Pacheco, V.A.; Caponcello, M.G.; Carrara, E.; Cataudella, S.; Camici, M.; Cascio, A.; Comai, G.; Cozzi-Lepri, A.; Dellacasa, C.; Monforte, A.D.; Gabrielli, L.; Gentilotti, E.; Gibertoni, D.; Lazzarotto, T.; López, I.; Maccarrone, G.; Madeddu, G.; Mazzaferri, F.; Morelli, M.C.; Pellicanò, G.; Palacios, P.P.; Piconi, S.; Potena, L.; Rodanò, A.; Baño, J.R.; Rossi, E.; Sangiovanni, N.; Salvaterra, E.; Santoro, A.; Visentin, A.
- Publication year: 2025
- Type: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/696507
Abstract
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.