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. 2025 Jun;31(8S):S3-S13.
doi: 10.1016/j.cmi.2025.02.010. Epub 2025 Feb 13.

ORCHESTRA Delphi consensus: diagnostic and therapeutic management of SARS-CoV-2 infection in solid organ transplant recipients

Beatrice Tazza  1 , Natascia Caroccia  1 , Alice Toschi  2 , Renato Pascale  3 , Effrosyni Gkrania-Klotsas  4 , Paula Olivares Navarro  5 , Lorenzo Maria Canziani  6 , Alessandro Tavelli  7 , Andrea Antinori  8 , Paolo Antonio Grossi  9 , Maddalena Peghin  9 , Evelina Tacconelli  6 , Zaira Raquel Palacios-Baena  5 , Pierluigi Viale  3 , Maddalena Giannella  10 ; Expert team and ORCHESTRA WP4 working group. Expert team Group Authorship; WP4 Working Group
Collaborators, Affiliations
Free article

ORCHESTRA Delphi consensus: diagnostic and therapeutic management of SARS-CoV-2 infection in solid organ transplant recipients

Beatrice Tazza et al. Clin Microbiol Infect. 2025 Jun.
Free article

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.

Keywords: COVID-19; Consensus; Delphi; Diagnosis; Risk of progression; SOT; Treatment.

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