Impact of COVID-19 on kidney transplantation

 There is a significant decline in kidney transplantation 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, writes Dr Bharat Shah, Director, Institute of Renal Sciences, Global Hospital, Mumbai

As COVID-19 spreads to large number of countries, the World Health Organization (WHO) in the month of March declared it a pandemic.

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

Due to the lockdown, there was a significant reduction in the number of transplants. In fact, the transplant programme stopped during nationwide lockdown. There were no living donor transplants and there were five cases of brain-stem death identified in Mumbai during this period, but noone could become a donor 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.

With regards to 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 post-operative period and after hospital discharge, transplanted patients have increased susceptibility to SARS-CoV-2 infection owing to induction therapy and immuno-suppressive treatment. Due to this, even the patients were reluctant for transplant and particularly kidney transplant patients, because they have an alternative in the form of dialysis.

Beginning 1^st June, the lockdown was released. By this time, with better understanding of COVID-19 and availability of anti-viral and anti-inflammatory drugs, the recovery rate of COVID-19 patients steadily improved.

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.

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.