Transplantation in the era of the Covid‐19 pandemic: How should transplant patients and programs be handled?

Abstract

Summary Due to the Covid‐19 pandemic caused by SARS‐CoV‐2, transplant programs worldwide have been severely impacted with dwindling numbers of transplantations performed and a complete halt in several areas. In this review we examine whether SARS‐CoV‐2 infection presents differently in transplant recipients, whom and how we should test, how susceptible the transplant population is to overt infection and describe the range of outcomes. From retrieved published reports on SARS‐CoV‐2infections in 389solid organ transplant recipients reported in the literature, the overall mortality rate was 16.7% ( n = 65); however for those with mild or moderate Covid‐19 disease this was 2.9% and 2.3% respectively; conversely, for those with severe infection the mortality rate was 52.2%.We then address questions regarding halting transplantation programs during this pandemic, whether all human tissues being considered for transplantation are capable of transmitting the infection, and if we should alter immunosuppressive medications during the pandemic.

Comprehensive Immune Profiling of a Kidney Transplant Recipient With Peri-Operative SARS-CoV-2 Infection: A Case Report

“…Our patient however tested positive for CMV viremia at week 14 which would be a more plausible explanation for this phenomenon, rather than the original COVID-19 infection, although 'second wave' responses have been reported (18). Whether immunosuppression should be empirically reduced in transplant patients with a COVID-19 infection remains controversial (19,20). In this instance, we chose to proceed with standard induction and maintenance immunosuppression due to the patient's favourable clinical characteristics and his relatively mild COVID-19 course.…”

“…Whether immunosuppression should be empirically reduced in transplant patients with a COVID-19 infection remains controversial ( 19 , 20 ). In this instance, we chose to proceed with standard induction and maintenance immunosuppression due to the patient’s favourable clinical characteristics and his relatively mild COVID-19 course.…”

Immunosuppression in kidney transplant recipients with COVID-19 infection – where do we stand and where are we heading?

“…There is still some debate regarding the ideal management of glucocorticoid therapy in COVID-19 infected organ transplant recipients. Most clinicians opt to continue glucocorticoids [4]. This practice is supported by the RECOVERY trial demonstrating reduced mortality with dexamethasone therapy in hospitalized nontransplant COVID-19 patients receiving respiratory support [5].…”

Kidney Transplantation in COVID Pandemic—A Review of Guidelines

“…The decision about limiting a transplant service or reopening it must consider patient wellbeing, prevalence of infection within the local community and the capability of a particular centre to manage the workload while maintaining infection control procedures and respecting recipient and donor autonomy [6].…”