COVID-19 is a novel, rapidly changing pandemic: consequently, evidence-based recommendations in solid organ transplantation (SOT) remain challenging and unclear. To understand the impact on transplant activity across the United States, and center-level variation in testing, clinical practice, and policies, we conducted a national survey between March 24, 2020 and March 31, 2020 and linked responses to the COVID-19 incidence map. Response rate was a very high 79.3%, reflecting a strong national priority to better understand COVID-19. Complete suspension of live donor kidney transplantation was reported by 71.8% and live donor liver by 67.7%.While complete suspension of deceased donor transplantation was less frequent, some restrictions to deceased donor kidney transplantation were reported by 84.0% and deceased donor liver by 73.3%; more stringent restrictions were associated with higher regional incidence of COVID-19. Shortage of COVID-19 tests was reported by 42.5%. Respondents reported a total of 148 COVID-19 recipients from <1 to >10 years posttransplant: 69.6% were kidney recipients, and 25.0% were critically ill. Hydroxychloroquine (HCQ) was used by 78.1% of respondents; azithromycin by 46.9%; tocilizumab by 31.3%, and remdesivir by 25.0%. There is wide heterogeneity in center-level response across the United States; ongoing national data collection, expert discussion, and clinical studies are critical to informing evidence-based practices. K E Y W O R D Sclinical decision-making, epidemiology, guidelines, infectious agents-viral

Prehabilitation is the process of enhancing pre-operative functional capacity to improve tolerance for the upcoming stressor; it was associated with improved post-operative outcomes in a handful of studies, but never evaluated in transplantation. Kidney transplant (KT) candidates may be uniquely suited for prehabilitation because they experience a profound loss of functional capacity while waiting years on dialysis. To better understand the feasibility and effectiveness of prehabilitation in KT, we conducted a pilot study of center-based prehabilitation for candidates; this intervention consisted of weekly physical therapy sessions at an outpatient center with at home exercises. We enrolled 24 participants; 18 participated in prehabilitation (75% of enrolled; 17% of eligible). 61% were male, 72% were African American, and mean age=52 (SD=12.9); 71% of participants had lower extremity impairment and 31% were frail. By 2 months of prehabilitation, participants improved their physical activity by 64% (p=0.004) based on accelerometry. Participants reported high satisfaction. Among 5 prehabilitation participants who received KT during the study, length of stay was shorter than for age, sex, and race-matched control (5 vs. 10 days; RR=0.69; 95%CI:0.50–0.94;P=0.02). These pilot study findings suggest that prehabilitation is feasible in pre-transplant patients and may potentially be a strategy to improve post-KT outcomes.

BackgroundFrailty has been recognized as an important medical syndrome in older adults. Growing literature supports the clinical application of frailty but US older adults’ perceptions of frailty have not been explored. We aim to examine perceptions and informational needs about frailty among older adults.MethodsThis was a qualitative study involving focus groups of community-dwelling older adults with diverse age and frailty status. We explored participants’ beliefs and knowledge about frailty and informational needs about frailty as a medical syndrome.ResultsThe participants’ mean age was 76.3. Of the 29 participants, 21 (72%) were female, and 21 (72%) were white. We identified three major themes: 1) Older adults’ perceptions of frailty differed from the definition used in medical literature; they often perceived a psychological component to being frailty and some were skeptical of the syndromic definition based on multiple symptoms. 2) Compared to participants who were non-frail or pre-frail, participants who were frail were more receptive to discussing their frailty status with clinicians; 3) Participants wanted know about how to treat or prevent frailty and the risks associated with being frail. Many participants felt that these information can be conveyed without necessarily using the specific term “frail”, which they perceived to have a negative connotation.ConclusionsOlder adults, especially those who are frail, may be interested to discuss frailty as a medical syndrome. However, negative perceptions are associated with the term “frail” and may be a barrier to clinical application of frailty. Further research is needed to understand acceptable ways for communicating about frailty in clinical practice.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0741-3) contains supplementary material, which is available to authorized users.

Background. Given the potential utility of frailty, a clinical phenotype of decreased physiologic reserve and resistance to stressors, to predict postkidney transplant (KT) outcomes, we sought to understand the perceptions and practices regarding frailty measurement in US KT programs. Methods. Surveys were emailed to American Society of Transplantation Kidney/Pancreas Community of Practice members and 202 US transplant programs (November 2017 to April 2018). Program characteristics were gleaned from Scientific Registry of Transplant Recipients. Results. The 133 responding programs (response rate = 66%) represented 77% of adult KTs and 79% of adult KT candidates in the United States. Respondents considered frailty to be a useful concept in evaluating candidacy (99%) and endorsed a need to develop a frailty measurement specific to KT (92%). Frailty measurement was more common during candidacy evaluation (69%) than during KT admission (28%). Of the 202 programs, 38% performed frailty assessments in all candidates while 23% performed assessments only for older candidates. There was heterogeneity in the frailty assessment method; 18 different tools were utilized to measure frailty. The most common tool was a timed walk test (19%); 67% reported performing >1 tool. Among programs that measure frailty, 53% reported being less likely to list frail patients for KT. Conclusions. Among US KT programs, frailty is recognized as a clinically relevant construct and is commonly measured at evaluation. However, there is considerable heterogeneity in the tools used to measure frailty. Efforts to identify optimal measurement of frailty using either an existing or a novel tool and subsequent standardization of its measurement and application across KT programs should be considered.

COVID-19 has rapidly and dramatically impacted the entire healthcare system, and it has had a profound impact on the field of solid organ transplantation (SOT). In our first national survey of US transplant centers in March 2020, we found that more than 75% of kidney and liver transplant programs were either suspended or operating under major restrictions. 1 Programs reported concerns about shortages of critical supplies, including SARS-CoV-2 tests, ventilators, and personal protective equipment (PPE). There was widespread variation in testing practices, clinical practice, and patient management, which may have been partially driven by regional differences in the incidence of COVID-19. This was consistent with the nationwide

No abstract

No abstract

Although many programs plan HIV D+/R+ transplantation, center-level barriers remain including geographic clustering of kidney/liver programs and concerns about HIV+ candidate willingness to accept HIV+ donor organs.