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Transplantation Learning Zone


Read time: 45 mins
How do you admit and manage solid organ transplantation patients in the era of COVID-19? Our experts, Dr Saima Aslam (Chair of the International Society of Heart and Lung Transplant COVID-19 taskforce) and Dr Federico Alberici (author of an early Italian single-centre study on kidney transplantation patients with COVID-19) share some practical advice across a range of clinical scenarios.

COVID-19 overview

The rapid worldwide spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has led to the ongoing coronavirus disease 2019 (COVID-19) pandemic. In the absence of a vaccine or approved therapy, the pandemic has had a considerable impact on the number of hospitalisations, ICU admissions and deaths worldwide. Those who are particularly vulnerable to severe COVID-19 appear to be those who are older and those with underlying health conditions such as hypertension and diabetes (Phua et al., 2020).

Solid organ transplantation patients who are on immunosuppressive treatments may be considered a vulnerable patient group for SARS-CoV-2 infection (Aslam & Mehra, 2020). Patients on the waiting list for transplant procedures may also face additional risks from infected donor organs. These risks are increasing, particularly as the global COVID-19 pandemic progresses; however, risks will vary depending on local infection rates. Healthcare professionals also face additional challenges that relate to infection control including the availability of clearly separated infrastructure that allow for safe patient admission pathways and resources such as personal protective equipment (PPE) and SARS-CoV-2 PCR testing. These requirements have led to major changes in organ procurement, patient admission pathways, the number of transplantation procedures taking place and patient management guidance.

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Organ procurement

Local guidelines from regions around the world are changing continuously as the COVID-19 pandemic progresses. In the USA, the American Society of Transplantation Infectious Disease Community of Practice has revealed new recommendations regarding organ donor testing, which is subject to change as more information becomes available (United Network for Organ Sharing, 2020). 

The recommendations include epidemiological screening (travel and exposure history of the donor), clinical screening (symptoms of COVID-19 such as fever, cough, flu-like symptoms) and laboratory testing (nucleic acid testing/PCR testing for SARS-CoV-2 infection) of both live and deceased organ donors (United Network for Organ Sharing, 2020).

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Managing existing transplant recipients

Existing solid organ transplant patients who are not infected with COVID-19 are not treated any differently in terms of immunosuppressant treatments; however, there have been significant changes in the management of these patients. 

These changes relate mainly to reducing the risk of SARS-CoV-2 infection. This primarily involves patient management using telemedicine, which reduces the need for patients to travel, and their chances of exposure to SARS-CoV-2.

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SARS-CoV-2 infected transplant recipients

The management of COVID-19 infected patients is dependent on COVID-19 severity. Limited observational studies indicate that solid organ transplantation patients admitted to hospital are generally more likely to die in response to SARS-CoV-2 infection; however, the reason for this is currently unclear (Alberici et al., 2020).

Dr Alberici highlights key complications that may arise in kidney transplant patients with COVID-19 and points out how these patients are managed differently to the general population.

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Akalin E, Azzi Y, Bartash R, Seethamraju H, Parides M, Hemmige V, et al. Covid-19 and Kidney Transplantation. N Engl J Med. 2020. doi:10.1056/nejmc2011117.

Alberici F, Delbarba E, Manenti C, Econimo L, Valerio F, Pola A, et al. Management Of Patients On Dialysis And With Kidney Transplant During SARS-COV-2 (COVID-19) Pandemic In Brescia, Italy. Kidney Int Reports. 2020. doi:10.1016/j.ekir.2020.04.001.

Aslam S, Mehra MR. COVID-19: Yet another coronavirus challenge in transplantation. J Hear Lung Transplant. 2020. doi:10.1016/j.healun.2020.03.007.

Association of Organ Procurement Organisations (AOPO). Accessed 10 June 2020.

Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation and Treatment Coronavirus (COVID-19). 2020. StatPearls Publishing Accessed 9 June 2020.

ERA-EDTA Registry, COVID-19: Information on Registry Initiatives. Accessed 10 June 2020.

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