|Year : 2022 | Volume
| Issue : 1 | Page : 1-2
COVID-19 and transplantation – A pathway to rebuild transplantation services
Darius F Mirza, Thamara Perera
The Liver Unit, University Hospital Birmingham NHS Trust and Birmingham Children's Hospital, Birmingham, UK
|Date of Submission||06-Mar-2022|
|Date of Acceptance||10-Mar-2022|
|Date of Web Publication||31-Mar-2022|
Prof. Darius F Mirza
University Hospital Birmingham NHS Trust and Birmingham Children's Hospital, Birmingham
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mirza DF, Perera T. COVID-19 and transplantation – A pathway to rebuild transplantation services. Indian J Transplant 2022;16:1-2
Delivery of organ transplantation for the treatment of end-stage disease has been drastically reduced in the past 2 years by the COVID 19 pandemic. The impact of the initial wave in early 2020 was severe fuelled by a lack of knowledge on COVID, a reduction in the deceased donor organ pool and the removal of resources to fight the pandemic, resulting in the almost complete collapse of organ transplantation worldwide. Transplantation activity was extremely restricted, essentially reserved for few life-saving transplants, where the risk of death without transplantation was high, in situations where the organ donor pool had not yet collapsed.
Healthcare systems were forced to prioritize dealing with COVID, which had the following effects on the delivery of organ transplantation:
- Resources were diverted with the redeployment of clinicians, nurses, coordinators, intensive care unit beds and management infrastructure
- As a disease COVID impacted patients with end-organ disease with higher disease incidence, with more significant disease and morbidity/mortality pre- and post-transplantation
- COVID had a direct and indirect impact on health-care professionals and transplant team composition, and
- Finally, there was a significant loss of confidence in being able to deliver safe transplantation.
The first attempts to re-establish transplantation began in mid-2020; early guidance was being made available, especially in the areas of transplantation for severe stage disease - with the emphasis being on saving lives and protecting teams., The second significant wave caused largely by the rapid spread of the virulent Delta variant resulted in more mortality in the general population, but there was a greater degree of preparedness to deal with the large patient load with more severe disease. Transplant services which had resumed before the Delta wave, continued although resource constraints severely impacted organ transplant volumes.
The year 2021 saw a massive and successful global vaccination drive, especially in countries with active transplantation services, such that by early 2022, a vast majority of adults have received at least two vaccine doses. The more recent third wave, caused by the omicron variant, has led to high transmission of a lower severity disease associated with a quicker recovery. There was justifiable initial worry with omicron, but this wave has evolved without significant morbidity through a largely vaccinated mobile adult population, allowing for the removal of “lockdown” restrictions that have been in place for 2 years.
The combination of successful vaccination and the milder omicron variant has led to the current situation of endemic, less severe COVID in the community, providing both confidence and return of resources to allow needy transplant patients access to transplantation. The current challenge is about how best to realize this resurgence in transplant activity and to make transplantation safe for both health-care providers and patients, and at the same time remain alert to making or even reversing changes, in the event of further waves with newer virulent variants.
The article by Asthana, et al. in this issue outlines simple current guidance on how to proceed with transplantation that balances risks and benefits to both patients and the teams looking after them, permitting rebuilding of safe transplantation services. This guidance is tailored to the needs of different organ systems and is different for life-saving transplants such as liver, cardiac, and lung transplants compared to elective renal transplantation or liver transplantation for less severe disease. Guidance includes the use of organs from both deceased and living donors, with symptomatic and symptomatic COVID infection, including the current approach to testing and the periods after infection when most clinicians feel it is safe to proceed with transplantation. Decision-making to proceed with transplantation should be made by individual transplant teams and their patients, working closely with hospital and regulatory authorities.
There is hope that for the first time in 2 years that the patients and the teams that look after them will not be adversely impacted by COVID, allowing life-saving organ transplantation to be re-established. It will take time to rebuild transplant services, with a long recovery anticipated to get to pre-pandemic practice of transplantation. There is the likelihood of further waves of varying virulence and there will be an ongoing evolution of vaccination policies, which will influence the rate of recovery. The eventual goal for the field of organ transplantation is to have a situation of dealing with COVID positivity like we deal with other endemic low virulence viruses like cytomegalovirus and Epstein-Barr virus.
| References|| |
Angelico R, Trapani S, Manzia TM, Lombardini L, Tisone G, Cardillo M. The COVID-19 outbreak in Italy: Initial implications for organ transplantation programs. Am J Transplant 2020;20:1780-4.
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An international multicenter study of protocols for liver transplantation during a pandemic: A case for quadripartite equipoise. J Hepatol 2020;73:873-81.
Thorburn D, Taylor R, Whitney J, Adair A, Attia M, Gibbs P, et al.
Resuming liver transplantation amid the COVID-19 pandemic. Lancet Gastroenterol Hepatol 2021;6:12-3.
Asthana S, Kute V, Shah U, Mohanka R, Sahay M, Chinnadurai R, et al
. Consensus statement on organ donation from COVID-positive deceased donors Indian Society of Organ Transplantation, Liver Transplant Society of India and Indian Society for Heart and Lung Transplantation. Indian J Transplant 2022;16:8-16. [Full text]