Table 2.

Agreed statements for kidney transplant practice during COVID-19 pandemic

Domain	Statement	Agreement (%)	Round
1. Kidney transplantation	S1.1 During COVID-19 pandemic, live donor transplantation should be delayed, unless urgent conditions apply	98	1
	S1.2 During COVID-19 pandemic, deceased donor renal transplantation should be performed only if COVID-19 free pathways can be ensured	96	2
	S1.3 During COVID-19 pandemic, renal transplantation should be ensured to immunized patients and to recipients facing urgent clinical conditions. Individualized decisions should be taken for the remaining patients	83	2
2. Screening for occult COVID-19 infection	S2.1 During COVID-19 pandemic, asymptomatic patients should be screened by nasopharyngeal swabs before proceeding to renal transplantation	94	1
	S2.2 During COVID-19 pandemic, asymptomatic patients with acute rejection should be screened by nasopharyngeal swabs before administration of anti-rejection treatments	83	1
3. Immunosuppressive therapy	S3.1 During COVID-19 pandemic, immunosuppression should be reduced in asymptomatic patients if nasopharyngeal swab is positive	87	1
	S3.2 During COVID-19 pandemic, immunosuppression should be reduced in symptomatic patients with positive nasopharyngeal swabs without clinical or radiologic evidence of lung disease	96	1
	S3.3 During COVID-19 pandemic, immunosuppression should be reduced in symptomatic patients with positive nasopharyngeal swabs with clinical or radiologic evidence of lung disease	94	1
	S3.4 During COVID-19 pandemic, in patients with positive nasopharyngeal swabs reduction of immunosuppression should be gauged as follows:   asymptomatic patients: withdraw of anti-proliferative agents;  symptomatic patients without clinical or radiologic evidence of lung disease: withdraw of anti-proliferative agents and m-TOR inhibitors. Reduction in the dose of calcineurin inhibitors  symptomatic patients with clinical or radiologic evidence of lung disease: withdraw of anti-proliferative agents, m-TOR inhibitors, and calcineurin inhibitors	87	2
	S3.5 During COVID-19 pandemic, in transplant recipients recovering from COVID-19, infection immunosuppression should be re-introduced 7–15 days after regression of symptoms, if nasopharyngeal swab is negative and after consultation with a specialist in Infectious Diseases	85	2
	S3.6 During COVID-19 pandemic, levels of immunosuppression should be adjusted in patients who receive concurrent antiviral therapies, after consultation with a specialist in Infectious Diseases according to possible drug interactions	93	1
4. Other pharmacological agents	S4.1 The use of Tocilizumab can be considered in kidney transplant recipients with severe pneumonia caused by SARS-CoV2 infection	98	1
	S4.2 Steroid boluses can be used in renal transplant recipients with severe pneumonia caused by SARS-CoV2 infection who need intensive care assistance	91	3
5. Management of kidney transplant recipients	S5.1 During COVID-19 pandemic, enrollment of patients in the wait list, for transplants from either deceased or live donors, could be delayed especially if the transplant center is located in an area with high prevalence of infection	95	3
	S5.2 During COVID-19 pandemic, kidney transplant recipients and their cohabitants should strictly adhere to basic protective measures against virus diffusion	100	2
	S5.3 During COVID-19 pandemic, active transplant programs must offer follow-up visits for patients in the early post-transplant period (3–6 months)	91	2
	S5.4 During COVID-19 pandemic, kidney transplant outpatients with flu-like symptoms, without dyspnea, should be managed through COVID-19 positive pathways, established for the general population. If hospitalization can be avoided, these recipients should be further assessed remotely. Reduction of immunosuppression could be advised	91	3
6. Healthcare professionals	S6.1 During COVID-19 pandemic, cooperative remote recipient surveillance programs should be established by central transplant agencies, to offer post-transplant care to recipients from centers that have become inactive for outpatient services due to logistic or organizational constraints	89	1
	S6.2 During COVID-19 pandemic, remote expert consultation programs should be established by central transplant agencies, to assist single centers in difficult management decisions for outpatient recipients	91	1
	S6.3 During COVID-19 pandemic, post-transplant outpatient clinics, in addition to the general safety measures, should include a dedicated space to manage patients with suspected viral infection. Standard safety procedures include surface disinfection after each visit	83	2
	S6.4 During COVID-19 pandemic, healthcare professionals working in post-transplant outpatient clinics should wear first level personal protection equipment (surgical facemask, disposable isolation gowns and gloves)	96	2
	S6.5 During COVID-19 pandemic, asymptomatic transplant professionals with positive nasopharyngeal swabs, must be placed on quarantine	91	1
	S6.6 During COVID-19 pandemic, healthcare professionals taking care of kidney transplant recipients, once positive for COVID-19 on nasopharyngeal swab, should stop their clinical activities and be isolated	93	2
7. Assessment of donor	S7.1 During COVID-19 pandemic, live donors who have overcome SARS-CoV2 infection, with a currently negative nasopharyngeal swab, can be considered for donation only after a follow-up period of at least 3 months. In general, live donor renal transplantation should be delayed until the end of the pandemic, unless urgent conditions apply	93	2
	S7.2 During COVID-19 pandemic, nasopharyngeal swabs should be obtained from all deceased donors	89	1
	S7.3 During COVID-19 pandemic, nasopharyngeal swabs should be obtained from all live donors in the 24 h before donation	87	1
	S7.4 During COVID-19 pandemic, considering that nasopharyngeal swabs may be falsely negative, deep airway swabs should also be obtained from deceased donors	89	2