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.
ORCHESTRA Delphi consensus: diagnostic and therapeutic management of SARS-CoV-2 infection in solid organ transplant recipients / Tazza, Beatrice; Caroccia, Natascia; Toschi, Alice; Pascale, Renato; Gkrania-Klotsas, Effrosyni; Navarro, Paula Olivares; Canziani, Lorenzo Maria; Tavelli, Alessandro; Antinori, Andrea; Grossi, Paolo Antonio; Peghin, Maddalena; Tacconelli, Evelina; Palacios-Baena, Zaira Raquel; Viale, Pierluigi; Giannella, Maddalena; Pierrotti, Ligia; Manuel, Oriol; Mularoni, Alessandra; Avery, Robin; Paniagua, Maria; Bartoletti, Michele; Carbone, Javier; Valerio, Maricela; Mueller, Nicolas; Los-Arcos, Ibai; Bodro, Marta; Gkrania-Klotsas, Effrossyni; Graziano, Elena; Balsamo, Maria Luisa; Rinaldi, Matteo; Pascale, Renato; Bonazzetti, Cecilia; Giannella, Maddalena; Tazza, Beatrice; Grossi, Paolo; Peghin, Maddalena; Addis, Elena; Azzini, Anna; Pacheco, Virginia Almadana; Caponcello, Maria Giulia; Carrara, Elena; Cataudella, Salvatore; Camici, Marta; Cascio, Antonio; Comai, Giorgia; Cozzi-Lepri, Alessandro; Dellacasa, Chiara; Monforte, Antonella D'Arminio; Gabrielli, Liliana; Gentilotti, Elisa; Gibertoni, Dino; Lazzarotto, Tiziana; López, Inmaculada; Maccarrone, Gaia; Madeddu, Giordano; Mazzaferri, Fulvia; Morelli, Maria Cristina; Pellicanò, Giovanni; Palacios, Patricia Pérez; Piconi, Stefania; Potena, Luciano; Rodanò, Alessandra; Baño, Jesús Rodríguez; Rossi, Elisa; Sangiovanni, Nadia; Salvaterra, Elena; Santoro, Andrea; Visentin, Alessandro. - In: CLINICAL MICROBIOLOGY AND INFECTION. - ISSN 1198-743X. - 31:8(2025), pp. S3-S13. [10.1016/j.cmi.2025.02.010]
ORCHESTRA Delphi consensus: diagnostic and therapeutic management of SARS-CoV-2 infection in solid organ transplant recipients
Madeddu, Giordano;
2025-01-01
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
