key: cord-0055597-idcvlohk
authors: Li Marzi, V.; Campi, R.; Pecoraro, A.; Peris, A.; Serni, S.
title: Feasibility and safety of kidney transplantation from deceased donors during the COVID-19 pandemic: Insights from an Italian academic center()
date: 2020-11-27
journal: nan
DOI: 10.1016/j.acuroe.2020.11.006
sha: 6372fbff2e6f8ee6424acf922ccd91634c8e855a
doc_id: 55597
cord_uid: idcvlohk

nan

Virtually all kidney transplantation (KT) Centers worldwide have been forced to rapidly adapt to the challenges raised by the COVID-19 pandemic. 1 Notably, KT recipients diagnosed with COVID-19 have experienced adverse clinical outcomes, 2,3 posing concerns on the safety of KT during this period. As such, the number of donations and KTs from deceased donors has suffered a critical reduction in several Countries. 4 In this scenario, while KT programs from living donors have been suspended at most Centers (including ours), whether KT programs from deceased donors should be continued during such an emergency scenario is still matter of ଝ Please cite this article as: Li Marzi V, Campi R, Pecoraro A, Peris A, Serni S. Viabilidad y seguridad del trasplante renal de donante fallecido durante la pandemia por COVID-19: perspectivas de un hospital universitario italiano. Actas Urol Esp. 2020. https://doi.org/10.1016/j.acuro.2020.03.016 * Corresponding author. E-mail address: riccardo.campi@gmail.com (R. Campi).

debate. 5 Moreover, there is still lack of data on the rate of COVID-19 after KT, as well as on the safety of minimallyinvasive surgery in this setting. Yet, being KT from deceased donors a highly valuable "urgent" surgical procedure, maintaining this activity even during emergency scenarios is paramount.

To provide insights in this regard, herein we report our experience of KT from donors after brain death (DBD) during the trimester February-April 2020 (COVID-19 period), comparing its outcomes with those of KT performed in the same timeframe in the years 2017---2019 (no-COVID period) ( Fig. 1) .

At our Center, located in one of the Italian Regions that have been hit the most by COVID-19, a series of logistical and clinical measures were implemented early after the spread of the epidemic aiming to prevent transmission of the disease to KT recipients (Fig. 2) .

Overall, the kidney procurement and transplantation activities did not change significantly during the COVID-19 period (Fig. 3) .

Thirty-three KTs were included in the analytic cohort (12 in COVID vs. 21 in the no-COVID period) ( 

Recipient ASA score (median, IQR)

Previous transplantation (n, %) 2 (6.1) 2 (9.5) 0 (0) 0.2 

Robotic Surgical approach (n, %)

Acute rejection (n, %) the donors' profile was similar between the two groups, we observed that recipients in the trimester Feb-Apr 2020 were less frequently pre-emptive (0% vs. 19%, p = 0.003) and had longer median dialysis periods before KT (50 vs. 24 months, p = 0.016). The proportion of robotic KTs was similar in the two groups (23.8% vs. 25%). Moreover, cold ischemia time, as well as intra/post-operative outcomes and median length of hospitalization, did not differ between the two study periods. While a higher rate of delayed graft function was recorded in patients undergoing KT during the COVID-19 period, median estimated glomerular filtration rate (eGFR) at hospital discharge was similar between the study groups (43 vs. 41 ml/min/1.73 m 2 , p = 0.9). None of the 12 recipients undergoing KT in 2020 was diagnosed with COVID-19 during the postoperative course, as none of the 210 patients currently in the waiting list for KT at our Center. At last, to date, we recorded 7 COVID-19 cases among the 140 patients in dialysis (with 2 diseaserelated deaths) and 2 cases among the 860 KT recipients in the outpatient setting. • LDTCs, RTC, the Operations Centre for management of ICU beds and the CNT to monitor the variations in the number of ICU beds in no-COVID Hospitals, highlighting the opportunities for organ procurement (both from DBDs and DCDs) at both regional and national level Involvement of Hospitals' LTDC in the pathway for time-dependent diseases (stroke, myocardial infarction, cardiac arrest, major trauma), to ensure effective working models 24h/24, facilitating specific pathways for imaging and laboratory analyses (including donor screening), optimizing the time efficiency of the donation process. In addition, in April we accepted for kidney transplantation 2 kidneys from another North-Italian Region that experienced severe logistical challenges in allocation of the graft in that period. Tuscany had officially declared that transplant activity should have been maintained active during the pandemic, being an "urgent procedure" (deliberation n. 572, May 4th 2020, Regional Council of Tuscany, available at: https://www.regione.toscana.it). In particular, transplant centers were asked to ensure the historical proportionality between offered organs (from both regional and extra regional procurement centers) and transplanted organs, respecting the safety principles released by the Regional Transplant Center and the Italian Transplant Authority.

Although the challenges caused by the COVID-19 pandemic may jeopardize the KT activity, our experience supports the feasibility and safety of KT from DBDs even during such emergency periods, provided both human and logistical resources allowing to achieve a timely and effective pathway for donation and transplantation.

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