Is It Time to Implement Self-customized Protocol of Doing Live Donor Renal Transplantation during Covid-19 Pandemic? : A High Volume Center-based Study in Bangladesh

Abstract

Background: COVID-19 (coronavirus disease of 2019) pandemic has stretched the healthcare system worldwide. Chronically ill patients like patients of end-stage renal disease are in big trouble of highly likely to be infected with coronavirus who requires frequent hospital visits. For the last few years, we are doing four live renal transplants per week; so it is very difficult to stop this program suddenly at the start of pandemic. We think that transplantation can isolate and separate these patients in relatively better way in comparison to dialysis. Due to several constraints and limitations, we did not follow the recommended surgical protocols of COVID-19 but we strictly followed our center-based self-customized strategy during perioperative period to continue our program and to ensure maximum safety to our patients. This paper is to discuss our modified strategy of renal transplantation during whole pandemic period with their outcomes in Center for Kidney Diseases and Urology Hospital, Dhaka, Bangladesh. Methods: We retrospectively analyzed the data of 300 transplant recipients who underwent renal transplantation during this pandemic along with total 18 members of operation theatre staffs. Written consent was taken clearly from every patient discussing what we are going to do with a clearance from medical board prior to transplantation. Asymptomatic with biochemically and radiologically negative for COVID-19 disease patients were selected for surgery. No selected patients or operation theatre staff underwent RT-PCR (reverse transcription- polymerase chain reaction) for COVID-19 tests prior to surgery. We took several special precautions, such as: identification and isolation of the symptomatic staff or patient, wearing mask, repeated hand sanitization, limiting the number of operation theatre staffs, strict restriction of patients’ attendant during hospital stay, a fixed time and day for follow up visit in a zone isolated from general patients, minimal hospital stay specially in lab area during follow up and hotline communication system by a dedicated medical team. Any surgical team member or transplanted patient who developed symptoms of COVID-19 disease was evaluated by a specialist and treated accordingly. Incidence of COVID-19 among recipients and operation theatre staffs with their outcomes as well as early outcomes of graft functions were recorded. Results: Out of 300 recipients, none developed symptoms of COVID-19 during hospital stay before discharge. Total of 18 (6%) patients presented with symptoms of COVID-19 disease during first 4 weeks of discharge, out of them 10 (55.55%) were RT-PCR for COVID-19 positive and 2 (20%) COVID-specific deaths were observed in ICU. Among operation theatre staffs, 3 (16.67%) were confirmed as COVID-19 positive and cured in home isolation. There were total of 7 (2.33%) deaths due to COVID-19 and other complications. Conclusion: The incidence rate of COVID-19 infection is much lower in recipients but death rate is significantly higher in comparison to general population. This study is designed to raise the question of whether strict surgical recommendation of COVID-19 is to be followed during renal transplantation or the time has come to implement more convenient but feasible strategy.