Impact of COVID 19 on kidney transplantation

27/07/2020

Coronaviruses are a large family of viruses that cause respiratory infections. These can range from the common cold to more serious diseases. COVID-19 is the disease caused by a new coronavirus. It was first reported in December 2019 in Wuhan City in China. As COVID 19 spread to large number of countries, the World Health Organisation (WHO) on 11.03.2020 declared COVID-19 a pandemic.

The first case of COVID-19 in India, was reported on 30 January 2020. As numbers kept on increasing, on 24 March, the Prime Minister ordered a nationwide lockdown for 21 days, affecting the entire 1.3 billion population of India. On 14 April, the PM extended the nationwide lockdown till 3 May which was followed by two-week extensions starting 3 and 17 May.

Because of the lockdown, there was a significant reduction in the number of transplants. In fact, the transplant program stopped during nationwide lockdown. There were no living donor transplants and there were 5 cases of brain-stem death identified in Mumbai during this period, but none could become donors due to practical problems. These include scarce resources (e.g., beds, operating theatres, medics, and nurses) and a logistical difficulty in ensuring clean and microbiologically safe pathways within hospitals for transplant patients.

As regards, kidney transplant procedures, there was fear among doctors that SARS-CoV-2 infection could be missed in both donors and recipients who are asymptomatic owing to the sensitivity issues with the RT-PCR test. Additionally, in the immediate postoperative period and after hospital discharge, transplanted patients have increased susceptibility to SARS-CoV-2 infection owing to induction therapy and immunosuppressive treatment. Because of this even the patients were reluctant for transplant and particularly kidney transplant patients because they have an alternative in the form of dialysis. Beginning June 1, the lockdown was released. By this time, with better understanding of COVID-19 and availability of antiviral and anti-inflammatory drugs the recovery rate of COVID-19 steadily improved.

Timely case identification” and “proper clinical management”. The recovery rate has been steadily increasing. In my opinion, with proper evaluation of recipient and donor which includes epidemiologic history, clinical history, throat swab for RT PCR and HRCT chest and with proper care in the hospital, kidney transplantation can be performed in the current situation. It is important to discuss with the patient that despite taking all precautionary measures, a small risk of covid infection remains and a dedicated consent form would help patients make well informed decisions. The significant decline in kidney transplantation is due to uncertainty regarding the risk of developing COVID-19 infection and its impact on recipients and also because these patients have an alternative in the form of dialysis.

 

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