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Pediatric transplantation in Europe during the COVID-19 pandemic: Early impact on activity and healthcare
Authors:Daniele Doná  Juan Torres Canizales  Elisa Benetti  Mara Cananzi  Federica De Corti  Elisabetta Calore  Loreto Hierro  Esther Ramos Boluda  Marta Melgosa Hijosa  Luis Garcia Guereta  Antonio Pérez Martínez  Maribel Barrios  Patricia Costa Reis  Ana Teixeira  Maria Francelina Lopes  Piotr Kaliciński  Sophie Branchereau  Olivia Boyer  Dominque Debray  Marco Sciveres  Lars Wennberg  Björn Fischler  Peter Barany  Alastair Baker  Ulrich Baumann  Nicolaus Schwerk  Emanuele Nicastro  Manila Candusso  Jacek Toporski  Etienne Sokal  Xavier Stephenne  Caroline Lindemans  Marius Miglinas  Jelena Rascon  Paloma Jara  ERN TransplantChild
Affiliation:1. Pediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy;2. La Paz Institute of Biomedical Research - IdiPAZ, La Paz University Hospital, Madrid, Spain;3. Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy;4. Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child with Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy;5. Pediatric Surgery, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy;6. Pediatric Hematology, Oncology and Stem Cell Transplant Division, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy;7. La Paz Institute of Biomedical Research - IdiPAZ, La Paz University Hospital, Madrid, Spain

Pediatric Hepatology Department, La Paz University Hospital, Madrid, Spain;8. Pediatric Gastroenterology Intestinal Rehabilitation Unit, La Paz University Hospital, Madrid, Spain;9. Pediatric Nephrology Department, La Paz University Hospital, Madrid, Spain;10. Pediatric Cardiology Department, La Paz University Hospital, Madrid, Spain;11. Pediatric Pneumology Department, La Paz University Hospital, Madrid, Spain;12. Pediatric Nephrology and Kidney Transplantation Unit, Pediatrics Department, Faculdade de Medicina, Hospital de Santa Maria, Universidade de Lisboa, Lisbon, Portugal;13. Department of Pediatric Nephrology, Pediatric Service, Centro Materno Infantil do Norte, Centro Hospitalar do Porto, Porto, Portugal;14. Department of Pediatric Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal;15. Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland;16. Pediatric Surgery Department, Hospital du Kremlin Bicêtre, Le Kremlin Bicêtre, France;17. Service of Pediatric Nephrology, Hôpital Necker-Enfants Malades, AP-HP, Université de Paris Descartes, Paris, France;18. Pediatric Hepatology Unit, Reference Center for Biliary Atresia and Genetic cholestasis, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Centre, Paris, France;19. Pediatric Hepatology and Liver Transplantation, ISMETT UPMC Palermo, Palermo, Italy;20. Department of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden;21. Department of Pediatric Hepatology, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden;22. Department of Pediatric Nephrology, Karolinska University Hospital, Stockholm, Sweden;23. Pediatric Liver, Gastrointestinal and Nutrition Centre, King's College London School of Medicine at King's College Hospital, London, UK;24. Division of Pediatric Gastroenterology and Hepatology, Hannover Medical School, Children's Hospital, Hannover, Germany;25. Clinic for Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany;26. Centre for Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy;27. Department of Hepatology and Gastroenterology, Bambino Gesù Children Hospital, Rome, Italy;28. Section of Pediatric Oncology/Hematology, Department of Pediatrics, Skåne University Hospital, Lund, Sweden;29. Laboratoire d'Hépatologie Pédiatrique et Thérapie Cellulaire, Unité PEDI, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain (UCLouvain), Brussels, Belgium;30. Service de Gastroentérologie et Hépatologie Pédiatrique, Département de Pédiatrie, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium;31. Pediatric Blood and Marrow Transplantation Program, Prinses Maxima Centrum, Utrecht, Netherlands;32. Faculty of Medicine, Nephrology Center, Vilnius University, Vilnius, Lithuania;33. Centre for Pediatric Oncology and Haematology, Children's Hospital, Vilnius University Hospital, Vilnius, Lithuania

Abstract:The current pandemic SARS-CoV-2 has required an unusual allocation of resources that can negatively impact chronically ill patients and high-complexity procedures. Across the European Reference Network on Pediatric Transplantation (ERN TransplantChild), we conducted a survey to investigate the impact of the COVID-19 outbreak on pediatric transplant activity and healthcare practices in both solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT). The replies of 30 professionals from 18 centers in Europe were collected. Twelve of 18 centers (67%) showed a reduction in their usual transplant activity. Additionally, outpatient visits have been modified and restricted to selected ones, and the use of telemedicine tools has increased. Additionally, a total of 14 COVID-19 pediatric transplanted patients were identified at the time of the survey, including eight transplant recipients and six candidates for transplantation. Only two moderate-severe cases were reported, both in HSCT setting. These survey results demonstrate the limitations in healthcare resources for pediatric transplantation patients during early stages of this pandemic. COVID-19 disease is a major worldwide challenge for the field of pediatric transplantation, where there will be a need for systematic data collection, encouraging regular discussions to address the long-term consequences for pediatric transplantation candidates, recipients, and their families.
Keywords:adolescents  children  coronavirus disease 2019  COVID-19  hematopoietic stem cell transplantation  pediatric transplantation  post-transplant management  SARS-CoV-2  solid organ transplantation  young
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