key: cord-0869174-732f6u3t
authors: Wang, Yi; Liu, Huirong; Buhler, Leo H.; Deng, Shaoping
title: Strategies to halt 2019 novel coronavirus (COVID‐19) spread for organ transplantation programs at the Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, China
date: 2020-05-02
journal: Am J Transplant
DOI: 10.1111/ajt.15972
sha: b56ef45c6c4c5983ab67a36b66b06ae98df43993
doc_id: 869174
cord_uid: 732f6u3t

During the coronavirus outbreak in China, our center performed 16 organ transplants (10 kidney, 4 liver and 2 lung transplants, from January 24 to March 11, 2020) harvested from deceased donors. Regarding the strategies to prevent infections of COVID‐19, we implemented specific measures for the donor and recipient management, as well as prevention of hospital‐acquired infections. All 16 organ recipients had a favorable outcome without COVID‐19 infection. Our approaches aiming to interrupt the spread of coronavirus within the transplantation wards were successful and allowed us to maintain the transplantation program for deceased liver, kidney and lung recipients.

Originating from Wuhan and expanding throughout China and the world, the 2019 novel coronavirus (COVID-19) has caused worldwide attention 1, 2, 3 . As of March 21, the overall confirmed cases reached 0.2 million in 172 countries. In all Chinese Medical Centers, elective surgery and living donor transplantation have been suspended due to the rapid spread of the coronavirus. In contrast, deceased donor transplantations were mostly performed. Therefore, strategies to interrupt transmission within transplantation wards were essential. To date, we have performed at our center 10 kidney, 4 liver and 2 lung transplants (from deceased organ donors, from January 24 to March 11, 2020) during the coronavirus outbreak in China. Based on our experience in combating the coronavirus while performing these organ transplants, we

This article is protected by copyright. All rights reserved comprehensively address here the strategies for the prevention of the virus spread within the transplantation wards.

The potential organ donors were cleared for epidemiology history and should not have traveled from or had contact with people from epidemic areas. To guarantee that the potential organ donors were not COVID-19 virus carriers, the virus nucleic acid from pharyngeal swab specimens was determined, and chest CT was performed 4 . Only when they were confirmed negative for coronavirus could related laboratory tests as HLA typing of donor, antibody detection of the receptor and complement dependent cytotoxicity test could be performed. The virus nucleic acid test required 6 hours and the other tests 4 hours. In total, the screening period was approximately 10 hours.

The potential recipients were screened for coronavirus (nucleic acid determination and chest CT scanning) on admission day. Further, additional information was collected from the recipient such as travel history, close contacts, daily body temperature and respiratory symptoms. During the hospitalization period, recipients received COVID-19-related education, including source of infection, transmission routes, susceptible population, and personal protective procedures.

Meanwhile, they were given new surgical masks every six hours. Due to the low immunoreactivity of the recipients after transplantation, organ transplant recipients were aware of the importance of face masks and hand hygiene. In order to prevent potential panic and anxiety regarding COVID-19 for recipients, we collaborated with psychologists to provide consultations before each operation.

Post-transplant immunosuppression was maintained at usual doses.

Accumulating evidence suggests that fever and diarrhea are the main symptoms of COVID-19. As liver transplant recipients are prone to have diarrhea after operation, we distinguished these

This article is protected by copyright. All rights reserved symptoms from coronavirus-infected patients. Nevertheless, if the recipient had fever, cough, diarrhea or pulmonary infection manifestations (pulmonary edema or pulmonary patchy shadow by chest CT scanning), the patient was considered as suspected for contamination and was quarantined within an isolation ward. Inside the ward, we set up a buffer area, where the drugs and personal items for each patient were located. One doctor and one nurse would be responsible for the medical care of each isolated patient, and no other healthcare personnel would be allowed to enter this isolation ward. When entering the isolation ward, the doctor and nurse should wear disposable protective gowns, N95 masks, protective goggles, gloves and shoe covers. Oxygen saturation levels of the patient were measured frequently. For the nucleic acid determination, a pharyngeal swab specimen was collected for nucleic acid determination and once the result was negative, it had to be confirmed again 24 hours later. Chest CT scanning was also performed to confirm the absence of lung infection. When the nucleic acid results were negative twice and no lung inflammation was found on CT, the patient was transferred back to the regular transplantation ward.

Accompanying family members of recipients also received COVID-19-related screening as mentioned above. In addition, regular visits were only allowed at working hours under the permission of the chief nurse. Meanwhile, the body temperatures of visitors were monitored.

Since the state government announced the epidemic infection of COVID-19 in China, we set up a hospital-acquired infection prevention group dedicated at the Center for Organ Transplantation.

Several strategies related to the training of the healthcare personnel (HCP) and patients were carried out. We systematically trained all HCP by means of meetings, videos and group discussions. Their body temperatures were monitored daily. Those who had visited Wuhan or Hubei province were isolated at home for 14 days. While working at the Center for Organ Transplantation, HCP should wear surgical masks, protective hair cover, and gloves when they need to have close contact with the blood and body fluid from a patient. Hand hygiene was strictly

This article is protected by copyright. All rights reserved implemented. To prevent hospital-acquired infections, the gap between beds should be larger than 1.2 meters, and the HCP should keep a distance greater than 1.5 meters when communicating with patients. The floor was mopped with chlorine-containing disinfectant daily and the window was opened twice a day (30 minutes each time) for ventilation. Before the admission of new patients, the ward was disinfected with H 2 O 2 for 30 minutes.

With the implementation of the strategies listed above, from January 24 to March 11, we performed 16 organ transplant operations (10 kidney, 4 liver and 2 lung transplants). After the surgery, one liver transplant recipient had pulmonary edema, and two kidney transplant recipients had fever and signs of lung infection. All these patients received COVID-19-related examinations (nucleic acid determination and chest CT scanning), and all were finally negative for the novel coronavirus infection. With proper treatment, they recovered well. All 16 recipients were discharged from the hospital without major complications. Taken together, our approaches aiming to interrupt the spread of coronavirus in transplantation ward were successful, and they allowed us to maintain the transplantation program for deceased kidney, liver and lung transplant recipients.

Technical Advisory Group for Infectious H, 2020. COVID-19: what is next for public health?

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