The unprecedented Covid-19 climate has facilitated a paradigm shift in how healthcare is approached the world over. The virus has indeed emerged as a formidable foe leaving the policymakers, healthcare providers, and patients with a series of challenges. While various novel prevention and control measures are evolving almost every day, the highly vulnerable population such as those awaiting an organ transplant and those who are on immunosuppressants post a transplant remain in the pandemic-panic mode.
Challenges for a liver or kidney transplant in current times
Several challenges have emerged in the current COVID-19 pandemic situation and in our experience, the rate of transplant surgeries has reduced to almost 60% of what it was before March 2020. The reasons for this steep decline range from stalling elective procedures during the early phase of lockdown, lesser donor traffic at hospitals, fear of contracting the coronavirus infection amongst the recipients, lesser number of in-hospital brain deaths, and lesser access to advanced healthcare in certain populations due to travel restrictions.
In recent times we have seen several matched organs being thrown into the bins as medical waste due to the fear of contracting an infection during hospitalization and post-transplant due to immunosuppressants. However, transplant centers are taking stringent measures to ensure patient safety during hospitalization for surgery and post-operative follow-up visits.
Is it safe to receive a donor-graft during the pandemic?
Individuals awaiting liver, kidney, and other solid organ transplants have been under tremendous anxiety and fear because of the pandemic. Suffering through an end-stage liver or kidney disease and waiting for a matching donor organ can be very daunting for a patient. The panic of acquiring the coronavirus infection during the treatment or post-surgery has just added more apprehension towards a transplant.
There have been no reports of transmission of SARS-CoV-2 from donors to candidates. However, the risk of such a transmission cannot be negated. The LiverIndia transplants team takes several precautions to ensure that the living donor is not an active carrier of the coronavirus. These include
- Counseling living solid organ donors on strategies to prevent infection.
- Diagnostic testing of the candidates for active SARS-CoV-2 infection and the presence of COVID antibodies.
- Monitoring the donor for exposures and symptoms in the 14 days before the scheduled transplant.
Are transplant patients more susceptible to COVID-19?
Reports around the world suggest that the mortality rates are higher among transplant patients who contract COVID-19 compared to the general population. Short-term mortality rates are projected to be as high as 43-50% in early transplant patients with COVID-19 as compared to the general population in whom it remains 1-2%. However, the long term liver transplant survivors have a far lesser mortality rate if they acquire COVID-19 has been far lower.
This can be attributed to the fact that the transplant patients are on immunosuppressant medications which are essential to prevent graft rejection. These anti-rejection drugs suppress the body’s immunity thereby deeming the transplant patients to be highly vulnerable.
Transplant patients also tend to have a higher virus load and can shed the virus for a longer period. This has lead to an increased risk of hospitalization and the need for intensive care as compared to healthy individuals. These patients are also more prone to other concomitant bacterial or fungal infections which can worsen the prognosis.
What precautions should a post-transplant patient take?
Transplant patients remain under the extremely vulnerable category and will need to continue observing restrictions of social distancing and personal precautions to avoid contracting the SAARS-COV2.
They should not stop any medications without their transplant doctor’s advice and should keep up with their regular follow up appointments. Although most appointments have been moved to telemedicine some recipients will need to visit the doctor’s office in person so that the relevant diagnostic tests can be performed.
The hospitals are taking additional precautions to reduce patient traffic and increase sanitation efforts to prevent any cross-infection during hospital visits. All patients are being screened for COVID-19 symptoms before they enter the hospital. Should you have any concerns regarding your safety during your hospital visit, contact your transplant team ahead of your appointment. They will provide the relevant guidelines for your visit and answer any questions you may have.
Managing COVID-19 in transplant patients
Amid growing evidence, many physicians are still on the fence to embrace antiviral regimens for transplant patients who have contracted COVID-19 due to potential drug interactions. Titrating the immunosuppressants and conservative management of the symptoms has been the primary course of action.
If you or your loved one have received a liver or kidney transplant and experience any symptoms of COVID-19 such as fever, malaise, cough, or breathing difficulty, you should reach out to your doctor at the earliest. Early intervention can help mitigate disease severity and help
COVID-19 Vaccines for transplant patients
Little is known on the safety and efficacy of the COVID-19 vaccines in post-transplant patients. The jury is still out whether the vaccines are a safe course of action for the immunosuppressed candidates including transplant patients. There also exists significant ambiguity when the vaccines are to be administered to transplant patients.
While researchers and transplant teams hustle to understand the nature and the long-term effects of the coronavirus infection, it is crucial to shield the highly vulnerable individuals with end-stage liver disease and transplant recipients until concrete guidelines are established for optimal management of COVID-19 for them.
