Imam A, Tzukert K, Merhav H, Imam R, Abu-Gazala S, Abel R, Elhalel MD, Khalaileh A. Practical recommendations for kidney transplantation in the COVID-19 pandemic. World J Transplant 2020; 10(9): 223-229 [PMID: 32995318 DOI: 10.5500/wjt.v10.i9.223]
Corresponding Author of This Article
Ashraf Imam, MD, Attending Doctor, Transplantation Unit, Department of Surgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel. ash_imam04@hotmail.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Sep 18, 2020; 10(9): 223-229 Published online Sep 18, 2020. doi: 10.5500/wjt.v10.i9.223
Practical recommendations for kidney transplantation in the COVID-19 pandemic
Ashraf Imam, Keren Tzukert, Hadar Merhav, Riham Imam, Samir Abu-Gazala, Roy Abel, Michal Dranitzki Elhalel, Abed Khalaileh
Ashraf Imam, Hadar Merhav, Riham Imam, Samir Abu-Gazala, Abed Khalaileh, Transplantation Unit, Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
Keren Tzukert, Roy Abel, Michal Dranitzki Elhalel, Department of Nephrology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
Author contributions: Imam A and Tzukert K have contributed equally to the paper and share the first authorship; Elhalel MD and Khalaileh A equal contribution; Imam A, Khalaileh A and Merhav H contributed to the research idea and study design; Imam A, Imam R, Elhalel MD, Abu-Gazala S, Merhav H and Abel R contributed to the data acquisition; Khalaileh A, Elhalel MD and Merhav H contributed to the supervision or mentorship; all the authors contributed to the manuscript writing and editing.
Conflict-of-interest statement: There are no declared conflicts of interest of any of the authors of this manuscript which could lead to bias and there were no external funding sources used for this work.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ashraf Imam, MD, Attending Doctor, Transplantation Unit, Department of Surgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel. ash_imam04@hotmail.com
Received: May 11, 2020 Peer-review started: May 11, 2020 First decision: May 20, 2020 Revised: May 23, 2020 Accepted: August 24, 2020 Article in press: August 24, 2020 Published online: September 18, 2020
Abstract
Kidney transplantation at the time of a global viral pandemic has become challenging in many aspects. Firstly, we must reassess deceased donor safety (for the recipient) especially in communities with a relatively high incidence of coronavirus disease 19 (COVID-19). With respect to elective live donors, if one decides to do them at all, similar considerations must be made that may impose undue hardship on the donor. Recipient selection is also problematic since there is clear evidence of a much higher morbidity and mortality from COVID-19 for patients older than 60 and those with comorbidities such as hypertension, diabetes, obesity and lung disease. Unfortunately, many, if not most of dialysis patients fit that mold. We may and indeed must reassess our allocation policies, but this must be done based on data rather than conjecture. Follow-up routines must be re-engineered to minimize patient travel and exposure. Reliance on technology and telemedicine is paramount. Making this technology available to patients is extremely important. Modifying or changing immunosuppression protocols is controversial and not based on clinical studies. Nevertheless, we should reassess the need for induction therapy across the board for ordinary patients and the more liberal use of mammalian target of rapamycin inhibitors in transplant patients with proven infection.
Core Tip: Transplantation in areas with a high rate of the coronavirus disease 19 (COVID-19) infection may be risky for recipients, as there may be a risk of COVID-19 transmission from infected donors. All preventive measures should be taken while treating kidney transplant patients.
