Impact of COVID-19 on Global Kidney Transplantation Service Delivery: Interim Report

Abstract

This article gives a personal, historical, account of the impact of the COVID-19 pandemic on transplantation services. The content is based on discussions held at two webinars in November 2020, at which kidney transplantation experts from prestigious institutions in Europe and the United States reflected on how the pandemic affected working practices. The group discussed adaptations to clinical care (i.e., ceasing, maintaining and re-starting kidney transplantations, and cytomegalovirus infection management) across the early course of the pandemic. Discussants were re-contacted in October 2021 and asked to comment on how transplantation services had evolved, given the widespread access to COVID-19 testing and the roll-out of vaccination and booster programs. By October 2021, near-normal life and service delivery was resuming, despite substantial ongoing cases of COVID-19 infection. However, transplant recipients remained at heightened risk of COVID-19 infection despite vaccination, given their limited response to mRNA vaccines and booster dosing: further risk-reduction strategies required exploration. This article provides a contemporaneous account of these different phases of the pandemic from the transplant clinician’s perspective, and provides constructive suggestions for clinical practice and research.

Impact of the COVID-19 pandemic on services for patients with chronic kidney disease: findings of a national survey of UK kidney centres

“…Other publications have reported on similar adaptations to the whole kidney service provision in different countries though with variations [15][16][17][18][19]. For transplant services Papalois et al, based on webinar discussions, described broadly similar global findings, to the aforementioned review [20]. There were comparable findings in transplant services in different national settings [16,[21][22][23][24] with some again emphasising heterogeneity in response across settings [16,21,24].…”

“…Reduction in faceto-face outpatient activity may also have disproportionately affected these patients given the uncertainties facing them. Less has been written about this group in relation to the pandemic though adaptations to outpatient consultations, access surgery, a relative switch from HD to PD in incident patients have been described [34,37,38] as have changes to transplant surgical services [20][21][22][23][24]39]. Patients undergoing transplant follow-up also faced reduced outpatient opportunities, a switch to virtual consultations and less access to specialist nurses.…”

Back to the Future With Co-Stimulation Blockade

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The COVID pandemic that first gripped the world in 2020 caused social and economic dislocations; including healthcare in general, and clinical transplantation in particular [1]. Many transplant centers tried to reduce hospital admissions and direct contact between patients and providers, and there was widespread expansion of telehealth and remote medical services.

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Kidney replacement therapy patients with COVID-19 in the vaccine era: what do we need to know?

“…At the start of the COVID-19 pandemic, both Spain and the UK reported a higher incidence of COVID-19 in dialysis patients compared with transplant patients, possibly due to the limited self-isolation capacity of dialysis patients [ 3 , 4 ]. Patients with kidney failure requiring in-center hemodialysis (HD) should be prioritized for vaccination.…”