Every year only 50% of patients on the waiting list for a transplant undergo surgery and of these 1 in three develops a cytomegalovirus (CMV) infection. This is what emerged from the conference “Donation, a wealth not to be wasted. Cytomegalovirus infection, a threat after transplantation”, organized in Milan with the non-conditioning contribution of Takeda. For the leading experts, who have gathered at the Swiss Center, against the widespread pathogen it is “necessary to invest in post-intervention assistance, local screening and a multidisciplinary approach”.
In immunocompetent individuals, Cmv – reads a note – is generally asymptomatic or latent, while in those with immune compromise, such as in transplant patients, it can lead to the occurrence of serious complications, particularly in the eyes, lungs, liver, oesophagus, stomach, intestines and central nervous system, infections and even loss of the transplanted organ. In 2021, in Italy, 27% of transplant patients – details the note – developed CMV infection following the procedure, generating a high hospitalization rate, which impacts on the patient’s life, as well as on the costs of the system regional health. Currently, the best way to limit the risk of contagion is careful personal hygiene, especially for the categories of people most vulnerable to the disease.
The conference was opened by Massimo Cardillo, Director General of the National Transplant Center (Cnt), who underlined how “the number of donations has grown and is growing as the data for the first months of 2023 tell us: comparing ourselves, in Europe , we are far from the Spanish benchmark, but in line with other countries. In any case, it is important not to hide the critical issues. To date – explains Cardillo – not all patients who need a transplant are able to obtain it: on the one hand we have 30% of the Italian sample who oppose the donation. These percentages of opposition, even higher than 50% registered in the elderly, are probably caused by various factors, not least that of thinking they are not suitable for the donation. We must insist, we know that today there are no contraindications to age-related donation. On this it is a priority to work through communication and information campaigns in synergy with the Ministry of Health and with all the associations. The second problem can be traced back to the identification of potential donors. We need to improve the organization of regional plans: we have around 8,000 patients waiting”.
In recent years there have been “improvements thanks to post-transplant monitoring – Corrado Girmenia of the Italian Group for bone marrow transplantation (Gitmo) has no doubts – therefore implementing strategies of this type is essential”. “Cytomegalovirus represents the main infectious complication – remarks Paolo Grossi, Director of the SC Infectious and Tropical Diseases (ASST of the Seven Lakes Varese) – it is necessary to build multidisciplinary teams capable of managing the complications. Fortunately, the survival rate in 2023 stands at 90%, a result that makes the transplant an effective procedure”.
To explore the need for an integrated approach, Fausto Baldanti, Director of UOC microbiology and virology Irccs Policlinico San Matteo in Pavia: “Interdisciplinarity is essential, even in training. Students must be able to acquire the necessary skills on the subject already in the curriculum and not only in specialty schools. Another fundamental point in 2023 is the updating of the diagnostic schemes for which clinicians, infectious disease specialists, transplantologists and microbiologists can interpret the data in an effective and integrated way, so as to be able to achieve better patient management”. It is essential to invest in “data sharing” and in “correct doctor-patient information – highlights Tiziana Nicoletti, head of Cnamc Cittadinanzattiva – a relationship that has entered into crisis in recent years precisely because of less reciprocity. The information process is essential that it take place gradually and based on trust”.
On the subject of communication to citizens, voluntary associations are fundamental. As explained by Flavia Petrin, President of Aido, “knowledge is the basis of the choice. We work so that people opt for the donation in life and do so by gathering all the necessary information. Saying “yes” costs nothing and is a choice for life. Technology at the moment is supporting us to spread knowledge as much as possible. From April it will be possible to say “yes” also through the Cie”.
“Our goal is to dialogue with scientific societies – explains Senator Elisa Pirro of the parliamentary intergroup on donation and transplantation – with the NTC, with patient associations. We want to arrive with proposals based on real needs. It is essential that there is a new management paradigm that is homogeneous throughout the national territory, which allows for faster procedures and adequate professional and economic resources. As an Intergroup, our desire is to support the scientific world and the political world to ensure that we can work in synergy as a team to implement activities of primary importance such as screening campaigns for CMV and promote therapeutic adherence in the community of patients.”
For Giuseppe Piccolo, director of the Lombardy Regional Transplant Center “for many years the Region has evaluated the excellence of transplants by measuring it through a numerator. Now it is necessary to adopt a regional program with common objectives and homogeneous measurement systems. In February 2023 we exceeded the national average and to continue with the correct planning of donation and transplantation we need hospitals to keep the level of attention on the subject high”. Piccolo also wanted to underline the importance of a systemic and integrated approach: “we are a network. The success of the process belongs to the whole work group involved, but also to the patient, who remains the sole administrator of the good received”.
“The Takeda approach to rare diseases – says Andrea Degiorgi, Rare Business Unit Head of Takeda Italy, a leading company in the biopharmaceutical sector – is focused on the entire patient journey. The donation is a wealth to be safeguarded also through the improvement of post-transplant assistance, the promotion of research and innovation, the sharing of data and experiences and the effective monitoring of therapeutic adherence.” For this, he continues, “we need to work to reduce the risk of infections, such as cytomegalovirus, which affect almost 1 in 3 patients post-transplant. This is enormous damage to the patient’s life, with an impact also on the health system In this sense, the multidisciplinary approach and the integrated and systemic vision are fundamental”.
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