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. 2021 Aug;23(4):e13600.
doi: 10.1111/tid.13600. Epub 2021 Mar 31.

Kidney transplantation in the time of COVID-19: Dilemmas, experiences, and perspectives

Marina P Cristelli  1 , Laila A Viana  1 , Ruan de A Fernandes  1 , Monica R Nakamura  1 , Renato D Foresto  1 , Suelen B Stopa Martins  1 , Jacqueline F L Alvarazi  1 , Valeria C Leite  1 , Francisco R de Oliveira  1 , Vanessa A Carneiro  1 , Daniel Wagner de C L Santos  1 , Wilson F Aguiar  1 , Maria Lucia Dos S Vaz  1 , Helio Tedesco-Silva  1 , José Medina-Pestana  1
Affiliations

Kidney transplantation in the time of COVID-19: Dilemmas, experiences, and perspectives

Marina P Cristelli et al. Transpl Infect Dis. 2021 Aug.

Abstract

Introduction: Hospital do Rim is a high-volume kidney transplant (KT) center located in São Paulo, a city with 12.2 million inhabitants. Over the last 18 years, we performed 11 436 KT, 70% of which from deceased donors. To mitigate the effects of reduction in the number of transplants on the waiting list, sequential measures were implemented when COVID-19 was declared pandemic.

Methods: The first step was to provide SARS-COV-2 RT-PCR testing for all symptomatic employees and patients and the compulsory use of personal protective equipment in the hospital facilities. Living donor KT were postponed, and all deceased donors and recipients were tested before the transplantation. The immunosuppressive protocols were maintained, and telehealth strategies were developed.

Results: Among the 1013 employees, there were 214 cases of COVID-19, nine required ward hospitalization, and no deaths occurred. In 26%, the probable source of contamination was occupational. From the first patient diagnosed with COVID-19 in 03/20/2020 till 10/21/2020, 523 deceased KT were performed, a 21% increase compared with 2019, with no confirmed donor-derived SARS-CoV-2 infection. Four patients were transplanted with a positive pretransplant SARS-CoV-2 test, but none of them developed the disease. Overall, of 11 875 KT followed in our center, 674 developed COVID-19. Among the hospitalized, 53% required mechanical ventilation, and 45% required hemodialysis. Their overall mortality rate was 27.5%.

Conclusion: This experience shows the challenges that transplant centers faced as the pandemic unfolded and illustrates the effectiveness of the sequential measures implemented to provide a safe environment for transplantation.

Keywords: COVID-19; kidney transplant; strategic planning.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

FIGURE 1
FIGURE 1
Cumulative number of COVID‐19 cases among employees and kidney transplant recipients and in the general population of the city of São Paulo (×100). First employee diagnosed COVID‐19 (+) on March 8, 2020. First patient diagnosed COVID‐19 (+) on March 20, 2020
FIGURE 2
FIGURE 2
Temporal distribution of the 220 cases of COVID‐19 among employees, per epidemiological week, according the source of contagion
FIGURE 3
FIGURE 3
Distribution of the 674 cases of COVID‐19 among kidney transplant recipients, per epidemiological week, according the reported source of contagion
FIGURE 4
FIGURE 4
Number of new kidney transplants per epidemiological week, according donor source. The first case of COVID‐19 in HRIM, in a late kidney transplant recipient, was diagnosed on March 20, 2020 (indicated with an asterisk
See this image and copyright information in PMC

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