Transplant programmes in areas with high SARS-CoV-2 transmission
Authors: Srikanth Reddy, Richard Dumbill, M Zeeshan Akhtar, Venkatesha Udupa, Ben M Storey, James Gilbert, Isabel Quiroga, Simon Knight, Andrea Devaney, Martin Barnardo, Thomas Connor, Udaya Udayaraj, Paul Harden, Edward Sharples, Phil Mason, Rutger J Ploeg, Peter J Friend, Sanjay Sinha
Journal: The Lancet (2020)

We read Alexandre Loupy and colleagues' account of a significant reduction in transplant activity in France and the USA with interest.1Loupy A Aubert O Reese PP Bastien O Bayer F Jacquelinet C Organ procurement and transplantation during the COVID-19 pandemic.Lancet. 2020; 395: e95-e96Summary Full Text Full Text PDF PubMed Scopus (216) Google Scholar The UK also has a high burden of COVID-19 with high severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission leading to a significant reduction in organ donation and transplant activity. In the UK, in April, 2020, only five out of 23 kidney transplant centres were active during lockdown.2NHS Blood and TransplantCOVID-19 bulletin number 7: organ and tissue donation and transplantation directorate.https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/18296/covid-19-bulletin-7-16-04-2020.pdfDate: April 16, 2020Date accessed: May 13, 2020Google Scholar According to NHS Blood and Transplant, on May 8, 2020, deceased-donor organ retrieval was down by 63% and kidney transplantation by 57% compared with 2019. The Oxford Transplant Centre is located in a hospital without an emergency department and is maintained as a COVID-19-free site—any suspected cases are isolated on a designated ward, and if confirmed are rapidly transferred to the main acute hospital. We have made profound system-wide changes to our practice covering donor and recipient selection, hospital logistics, and perioperative management to enable our transplant programme to continue, which are summarised in the appendix (pp 1–2). These changes have been highly effective. Between March 16 and May 12, 2020, we did 38 deceased-donor kidney transplants—27 from donation after brain death and 11 from donation after cardiac death. This compares with 16 kidney-alone transplants for the same period in 2019, a rise secondary to an increase in the number of offers as other transplant centres have closed. Follow-up times for these 38 transplants are 1–58 days; we have at least 7 days of follow-up for 31 cases. Initial results are reported here and summarised in the appendix. Median length of hospital stay was 5 days. 9 (29%) of 31 patients had delayed graft function, defined as any use of postoperative dialysis. All discharged patients are no longer dialysis dependent. During this short-term follow-up period none of these recipients have contracted SARS-CoV-2. Three were readmitted to hospital—one for peritoneal dialysis catheter related peritonitis, and two for management of diabetes. COVID-19 appears to be more prevalent in the UK haemodialysis population than the UK transplant population (8·6% vs 1·1%) with comparable mortality risk (22·5% vs 25·1%)—summarised in the appendix (p 5).3The Renal AssociationCOVID-19 surveillance report for renal centres in the UK. All regions and centres – up to 6 May 2020. The Renal Association, Bristol2020Google Scholar Our early results support the notion that a continued (albeit radically altered) transplant programme helps minimise pandemic risk in a highly vulnerable population. Soon transplant services might need to coexist with COVID-19 and, much as previous generations did in an earlier era of infectious disease, we will need to learn to segregate patients who are at risk. SK reports personal fees from OrganOx, unrelated to this Correspondence. All other authors declare no competing interests. We thank Retha Steenkamp, Head of Operations, UK Renal Registry, for supplying prevalence data for the UK Renal Replacement Therapy population. Download .pdf (.16 MB) Help with pdf files Supplementary appendix Organ procurement and transplantation during the COVID-19 pandemicEnd-stage organ failure is estimated to affect more than six million people worldwide.1 In 2018, transplant systems across the world enabled around 150 000 patients to benefit from a kidney, heart, lung, liver, or other solid organ—a number far less than the demand. According to data from WHO , more than 1 500 000 people live with a transplanted organ worldwide. In the USA, approximately 40 000 patients receive an organ transplant every year, but 120 000 patients remain on a waiting list for transplantation, with 7600 individuals dying annually while waiting for an organ transplant. Full-Text PDF