STRATEGIES TO HALT 2019 NOVEL CORONAVIRUS (COVID-19) SPREAD FOR ORGAN TRANSPLANTATION PROGRAMS AT THE SICHUAN ACADEMY OF MEDICAL SCIENCE AND SICHUAN PROVINCIAL PEOPLE’S HOSPITAL, CHINA

Abstract

Originated from Wuhan and expanded throughout China and the world, the 2019 novel coronavirus (COVID-19), has caused worldwide attention. As of March 21, the overall confirmed cases reached to 0.2 million in 172 countries. In all Chinese Medical Centers, elective surgery and the living donor transplantation has been suspended due to the rapid spread of the coronavirus. In contrast, the cadaveric donor transplantations were mostly performed. Therefore, strategies to interrupt transmission within transplantation wards were essential. To date, we have performed at our center ten cases of kidney, four liver and two lung transplants (from deceased organ donors) during the coronavirus outbreak in China (from January 24th to March 11th, 2020). Based on our experience in combating the coronavirus while performing these organ transplants, we comprehensively address here the strategies for the prevention of the virus spread within the transplantation wards. Donor management The potential organ donors were cleared for epidemiology history and should not have traveled from or have contact with people from epidemic areas. Virus nucleic acid from pharyngeal swab specimens was determined, and chest CT was performed. Only when they were confirmed negative for coronavirus, related laboratory tests as HLA typing of donor, antibody detection of the receptor and complement dependent cytotoxicity test could be performed. Recipient management The potential recipients were screened for coronavirus (nucleic acid determination and chest CT scanning) on admission day. Further, additional information was collected from the recipient such as travel history, close contacts, daily body temperature and respiratory symptoms. During the hospitalization period, recipients received COVID-19 related education. Meanwhile, they were given new surgical masks every six hours. We also collaborated with psychologists to provide consultations. Post-transplant immunosuppression was maintained at usual doses. If the recipient had fever, cough, diarrhea or pulmonary infection manifestations, the patient was considered as suspected for contamination and was quarantined within an isolation ward. Accompanying family members of recipients also received COVID-19 related screening as mentioned above. In addition, regular visits were not allowed. Prevention of hospital-acquired infections We implemented strict protocols in preventions of HAIs, including training of HCPs and providing personal protective equipment. Outcome of the organ transplant recipients From January 24th to March 11th, we successfully performed 16 organ transplant operations (10 kidney, 4 liver and 2 lung transplants).