Expert says transplantation should continue during COVID-19 pandemic
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A speaker at the virtual Global Innovations in Patient-Centered Kidney Care: International Summit discussed transplantation in the midst of the COVID-19 pandemic, arguing transplantation benefits may outweigh any potential risks.
Olivia Kates, MD, of the division of allergy and infectious diseases at the University of Washington, told the audience it is important to reflect on what the current data convey about transplantation, and how patients with kidney disease requiring dialysis have been impacted by the virus.
“We do not want to see patients get COVID-19 as a result of a transplantation, and [Organ Procurement and Transplantation Network ] OPTN currently recommends donors be tested for COVID-19,” she said. “If a patient can have a transplant, they may be able to avoid more health care contacts and potential COVID-19 exposure through dialysis.”
She added that she agrees with guidelines released by CMS which recommend transplants should continue even in the context of the pandemic, as long as these can be done safely.
Kates emphasized that evidence from a variety of studies does not demonstrate an increased risk for developing COVID-19 with transplantation. Rather, she said, the major factors of COVID-19 risk are age, comorbid conditions, Black race and health care exposure. While patients with kidney disease who are either on dialysis or who have received a kidney transplant are more likely than the general population to have these risk factors, she argued transplantation itself does not seem to confer an increased risk.
However, she acknowledged that living donors must be considered in making recommendations for transplantation during the pandemic.
Although patients who undergo transplantation (and therefore no longer require in-center dialysis treatments) may see a decreased risk for COVID-19 by limiting exposure, living donors will increase their risk through greater exposure possibilities.
“Because we have a special ethical responsibly to the living donor population, their safety needs to be prioritized,” she said. “Thankfully, these transplants are, in many cases, not urgent and can be safely deferred.”
Kates also touched on immunosuppression, noting that “the biggest question about transplant recipients with COVID-19 has been: What is the effect, if any, of immunosuppression on the disease process?”
According to Kates, while the reduction in immunosuppression has been widely used to manage respiratory viral infections for decades, some research suggests patients who continue on their immunosuppression regimens may actually achieve better clinical outcomes than those who have their immunosuppression stopped or reduced.
Addressing whether immunosuppression regimens should be changed preemptively to protect against COVID-19 or reduce the severity if acquired, she said she sees no evidence for this as no difference has yet been observed.
“So far, [we] have not seen a difference in COVID-19 outcomes based on what immunosuppression regimens transplant patients take at home,” she concluded. “It may not be necessary, or even helpful, to decrease immunosuppression when these patients become sick.”
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Kates O. Session 2. Presented at: Global Innovations in Patient-Centered Kidney Care: International Summit; July 16-17, 2020 (virtual meeting).
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