Should We Perform Old-For-Old Kidney Transplantation during the COVID-19 Pandemic? The Risk for Post-Operative Intensive Stay

Abstract

Health care systems worldwide have been facing major challenges since the outbreak of the SARS-CoV-2 pandemic. Kidney transplantation (KT) has been tremendously affected due to limited personal protective equipment (PPE) and intensive care unit (ICU) capacities. To provide valid information on risk factors for ICU admission in a high-risk cohort of old kidney recipients from old donors in the Eurotransplant Senior Program (ESP), we retrospectively conducted a bi-centric analysis. Overall, 17 (16.2%) patients out of 105 KTs were admitted to the ICU. They had a lower BMI, and both coronary artery disease (CAD) and hypertensive nephropathy were more frequent. A risk model combining BMI, CAD and hypertensive nephropathy gained a sensitivity of 94.1% and a negative predictive value of 97.8%, rendering it a valuable search test, but with low specificity (51.1%). ICU admission also proved to be an excellent parameter identifying patients at risk for short patient and graft survivals. Patients admitted to the ICU had shorter patient (1-year 57% vs. 90%) and graft (5-year 49% vs. 77%) survival. To conclude, potential kidney recipients with a low BMI, CAD and hypertensive nephropathy should only be transplanted in the ESP in times of SARS-CoV-2 pandemic if the local health situation can provide sufficient ICU capacities.

COVID-19 and the Kidney: From Epidemiology to Clinical Practice

“…In addition, for kidney transplants, it was necessary to develop preventive measures that could allow for their management. In particular, each Transplant Center had to evaluate the possibility of performing a kidney transplant in relation to the availability of intensive care units and the risk of ICU admission for the individual patient [138]. In addition, during the course of the COVID-19 pandemic, organ donation and transplantation experienced significant changes: organ authorization decreased by 11%; the number of organs transplanted decreased by 18%; and organ recovery for transplantation fell by 17% [139].…”

Old for young kidney transplantation: a responsible option for our patients to reduce waiting time?

“…The ESP or “old for old-program, was specifically developed to reduce waiting times for recipients aged ≥ 65 years by exclusively allocating kidneys from deceased donors ≥ 65 years [ 8 ]. Since its introduction in 1999, its outcomes were acceptable, even during COVID-pandemic [ 9 , 10 ]. Each year, about 500 kidneys are transplanted in this program [ 11 ].…”