key: cord-0813544-ofcfm0ra
authors: Wojas, W.; Kotowski, MJ.; Marczak, I.; Ostrowski, P.; Ostrowski, M.; Sieńko, J.
title: Outcomes of kidney transplantation during the SARS-CoV-2 pandemic at one centre in Poland.
date: 2022-04-11
journal: Transplant Proc
DOI: 10.1016/j.transproceed.2022.03.006
sha: 1514af2fb702aff86121ce0c141ee2ab4a5558ee
doc_id: 813544
cord_uid: ofcfm0ra

The SARS-CoV-2 pandemic has significantly affected the number of transplanted organs worldwide. In Poland the rules and restrictions related to transplantation activities are included in the updated guidelines of Poltransplant (Polish Organizational and Coordination Centre for Transplantation). Our clinic faces the same problems as the rest of the hospitals in the country. Not only is the number of recipients falling, but also there are numerous restrictions concerning, among other things, qualification of donors and recipients, or even preparation of centres for long-term care in the event of infection of organ recipients with the SARS CoV-2 virus. Statistics showed, after an initial fall in the number of kidneys transplanted, a temporary normalization during the summer months, only to record a fall again with an increase in new cases of COVID-19. A total of 29 kidneys were transplanted at our centre between March and December 2020. Kidney transplantation is not only linked to the operation itself, but also to the follow-up care of the recipients. Reduced immunity among recipients due to immunosuppressive treatment, as well as comorbidities among recipients, contribute to this group being at increased risk of symptomatic SARS CoV-2 infection. The number of cases of SARS CoV-2 infection among kidney transplant recipients at our centre was 7, of which we recorded 2 deaths due to COVID-19 infection in the post-kidney transplant period. Postoperative complications probably related to previous SARS CoV-2 infection occurred in one patient.

The COVID-19 pandemic has significantly affected the number of organs transplanted worldwide.

Not only is the number of recipients falling, but also numerous restrictions concerning e.g. Kidney transplantation at our centre Our centre faces the same problems as the rest of the centres across Poland. Performing additional tests, allocating patients, as well as preparing the team and department to work during the pandemic has been a challenge. In total, 29 kidneys were transplanted at our centre between March and December 2020. In our centre, as in the whole of Poland, we observed an initial drop in the number of transplanted kidneys, which was followed by an increase during the summer holidays, and then a decrease during the autumn and winter months, when the incidence of the disease increased again.

Comparing these figures to the 2019 statistics in the year before the pandemic, we transplanted one more kidney in 2020. In 2019, 28 kidneys were transplanted at our centre. (Fig.2) Kidney transplantation is not only linked to the operation itself, but also to the follow-up care of the recipients.

Reduced immunity among recipients due to immunosuppressive treatment, as well as co-morbidities such as hypertension, diabetes, ischemic heart disease, metabolic syndrome, contribute to the fact that this group is at increased risk of symptomatic SARS CoV-2 infection. Symptoms of COVID-19

infection are similar to those of the general population: cough, shortness of breath, fever, but more often than in the general population, gastrointestinal involvement with diarrhoea, causing dehydration, predominates in recipients. The concentration of acute phase protein (CRP, C-reactive protein) increases moderately with a normal concentration of procalcytonin, in a way typical for viral infections. Lymphopenia, large increases in d-dimers, ferritin and troponin are negative prognostic factors. [4] The number of cases of SARS-CoV-2 infection among renal transplant recipients at our centre was 7, of which we recorded 2 deaths due to COVID-19 infection in the post-renal transplant period.

Postoperative complications probably related to previous SARS-CoV-2 infection occurred in one patient in the form of increased intravascular coagulation.

The year 2020 was a year of new challenges for transplantation worldwide, as well as in Poland. The SARS-CoV-2 pandemic created new challenges in preparing and then managing recipients after kidney transplantation. Our centre, despite the pandemic, transplanted 1 more kidney than in 2019.

We had 24.14% of recipients infected after kidney transplantation at our centre with SARS-CoV-2 virus. 71.4% of the infected recipients recovered by becoming convalescents, while 26.8% of those infected with SARS-CoV-2 virus died. The experience gained in 2020 and new solutions, including the possibility of vaccinating recipients and the entire population, provide a new perspective for the coming years in the world and Polish transplantology.

Stanowisko Poltransplantu dotyczące wykorzystania narządów, tkanek i komórek innych niż komórki krwiotwórcze do przeszczepienia w związku z zakażeniem koronawirusem

Solid-organ transplantation in the period of COVID-19 epidemic