Should We Perform Old-For-Old Kidney Transplantation during the COVID-19 Pandemic? The Risk for Post-Operative Intensive Stay

Philip Zeuschner,Urban Sester,Michael Stöckle,Nasrin El-Bandar,Matthias Saar,Janine Mihm,Paul Ritschl,Ilias Zompolas,Lutz Liefeldt,Frank Friedersdorff,Thorsten Schlomm,Klemens Budde,Robert Öllinger

doi:10.3390/jcm9061835

Abstract

Health care systems worldwide have been facing major challenges since the outbreak of the SARS-CoV-2 pandemic. Kidney transplantation (KT) has been tremendously affected due to limited personal protective equipment (PPE) and intensive care unit (ICU) capacities. To provide valid information on risk factors for ICU admission in a high-risk cohort of old kidney recipients from old donors in the Eurotransplant Senior Program (ESP), we retrospectively conducted a bi-centric analysis. Overall, 17 (16.2%) patients out of 105 KTs were admitted to the ICU. They had a lower BMI, and both coronary artery disease (CAD) and hypertensive nephropathy were more frequent. A risk model combining BMI, CAD and hypertensive nephropathy gained a sensitivity of 94.1% and a negative predictive value of 97.8%, rendering it a valuable search test, but with low specificity (51.1%). ICU admission also proved to be an excellent parameter identifying patients at risk for short patient and graft survivals. Patients admitted to the ICU had shorter patient (1-year 57% vs. 90%) and graft (5-year 49% vs. 77%) survival. To conclude, potential kidney recipients with a low BMI, CAD and hypertensive nephropathy should only be transplanted in the ESP in times of SARS-CoV-2 pandemic if the local health situation can provide sufficient ICU capacities.

Highlights

Health care systems all over the world have been facing major and unprecedented challenges since the outbreak of Coronavirus Disease 2019 (COVID-19)
Potential kidney recipients with a low BMI, coronary artery disease (CAD) and hypertensive nephropathy should only be transplanted in the Eurotransplant Senior Program (ESP) in times of SARS-CoV-2 pandemic if the local health situation can provide sufficient intensive care unit (ICU) capacities
One (5.9%) patient was admitted to the ICU on postoperative day (POD) 36; he suffered from a late-onset sepsis

Summary

Introduction

Health care systems all over the world have been facing major and unprecedented challenges since the outbreak of Coronavirus Disease 2019 (COVID-19). Some countries were unexpectedly overwhelmed by a considerable increase in patients admitted to hospitals in need of intensive care [3]. PPE and ICU beds were urgently needed as scarce medical resources for the management of COVID-19 cases and for the protection of the medical staff [4,5]. Another reason for postponing elective surgeries was the fear that patients admitted to hospital for elective surgery would become vectors for the transmission of a nosocomial infection with SARS-CoV-2 [3,4]

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