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The donor’s test result is positive.
This transplant is unique because the donor was ill with a disease caused by a pandemic virus two weeks ago. “The multidisciplinary team actively discussed the suitability of the kidneys for transplantation. Information on organ transplantation from a donor with COVID-19 is still very limited, even in the international literature. The patients, who were familiar with the information about the donor’s disease, accepted this message calmly: the transplants were carried out, ”says nephrologist Eglė Ašakienė, head of the Organ Transplant Coordination Center of the Santara Clinics, about the event exceptional in a press release.
Head of the Center for Infectious Diseases prof. Ligita Jančorienė also emphasizes the uniqueness of this transplant: the donor, after diagnosing his brain death, had a positive molecular result for a coronavirus infection in the nasopharynx, and both recipients were already infected with this infection.
“We wondered if a similar transplant had been performed somewhere in the world and today we can say that we were the first. It is necessary to talk about this as much as possible, since the pandemic has already affected transplants and the number of people living and affected by the infection is increasing worldwide, so given the needs and the current medical options, you need to consider donor organ transplantation. . the opportunity to save human lives, curb insidious diseases and provide quality of life to many seriously ill people. “
According to the head of the Nephrology Center of Clinicas Santara prof. Marius Miglin, both on dialysis and after a kidney transplant, has higher morbidity and mortality from COVID-19 disease than the general population. As a result, especially at the beginning of the pandemic, there was a dilemma about whether or not transplants should be performed. However, as experience has been gained, transplant centers have learned to adapt to a complex and changing environment. It is understood that end-stage kidney disease may be more dangerous in some patients than the coronavirus infection itself.
Will propose a revision of the transplant guidelines.
Both donors and recipients are tested for COVID-19 prior to the planned transplant. However, the two kidney transplants performed at the Santara clinics in mid-January are special:
“In particular, both dialysis recipients had already developed COVID-19. The situation is so new that no guidelines provide or describe the ideal waiting time before kidney transplantation for dialysis patients who have recovered from kidney disease. Coronavirus: To date, only three cases of deceased donor transplantation have been documented worldwide in which a recipient has received a kidney transplant after recovering from COVID-19 disease.
On the other hand, in our case, the kidney donor was also sick with COVID-19 just two weeks ago. The adequate amount of protective anti-SARS-CoV-2 antibodies formed for our two recipients was determined, and the multidisciplinary team of the Santara clinics made the decision to perform the transplants ”, explains prof. M. Miglinas.
Based on the experience of these cases, transplant specialists at the Santara clinics will make suggestions to international organizations that the guidelines for pandemic transplants should be updated to take into account rapidly changing transplant scenarios.
Head of the Urology Center doc. Arūnas Želvys says that the number of people with COVID-19 has increased, so it is especially important when the patient is no longer contagious, when he can continue to receive planned help in case of other diseases, what changes are left in various organs after the disease.
These are the key questions that doctors would like to have answered. So far, it has not been clear how long should elapse after COVID-19. According to the latest data, the patient is no longer contagious 20 days after the onset of symptoms. Also, perhaps the infectivity of the patient is not determined by the number of days, but by the fact of the development of active immunity, which is reflected in the antibodies formed? Currently, every piece of information from around the world about the behavior of the virus is being analyzed by doctors at the Santara clinic and allows us to expand the limits of safe treatment.
During a pandemic, transplants are performed
According to the head of the Department of Resuscitation-Intensive Care doc. Mindaugas Šerpytis and Santara Clinics did their best to continue the donation process in Lithuania and during the pandemic. Organ transplantation requires a large number of staff, which is a great challenge for hospitals during a pandemic, as some doctors are isolated after contact with a patient with COVID-19 and the need for staff in care units intensive COVID-19, which have exchange commands:
“On the other hand, after organ transplantation, patients are treated in resuscitation-intensive care units, most of which are occupied by COVID-19 patients, which reduces the number of beds in resuscitation and intensive care units. for patients without COVID-19, “explains Doc M. Šerpytis.
The anesthesiologist-resuscitator Albinas Kalimavičius, who coordinated the donor preparation, says that this stage was performed for the first time in the red zone, especially in difficult conditions both physically and clinically.
Patients are closely monitored
According to doctor E. Ašakienė, the condition of the patients is currently good. One week after transplantation, PCR tests were performed on nasopharyngeal samples with no evidence of coronavirus infection, the kidney transplants from both recipients were already working, and dialysis was no longer required.
Patient Raimonda is extremely happy today because she feels so good. When the woman learned that the donor was also suffering from COVID-19, she immediately said “yes” because she relied heavily on equipment, doctors and modern medicine.
“Everything is going well so far and I would like to live with this kidney as long as possible,” says Raimonda. – I don’t allow myself to think that’s bad. The family is also happy, especially their thirteen-year-old son to give him more time. I would like to use my example to encourage others who may have a difficult time deciding or changing their attitude. “
As the woman recalls, it took 4.5 years to perform hemodialysis, it is not as painful as it is exhausting, it takes a long time: every two days you have to do dialysis, you never have to work, you cannot travel anywhere, it feels like if I was tied up.
“I had to wait a long time before doctors could add me to the transplant waiting list due to my health and complications, but then when I was already registered I received an invitation for a transplant within three months. When they invited me and told me that a suitable kidney is a person who has had a stroke, I didn’t even think it could be bad. And I myself got infected with this infection, during the second wave, in November. I went to the hospital for a couple weeks, but I think I got away pretty easily. “
The 36-year-old woman, who had the second kidney from this donor, is also optimistic, hoping for the best. He was diagnosed with nephropathy in 2008, but the disease did not progress for eight years. In the ninth year, he began to deteriorate dramatically, had to undergo peritoneal dialysis for 1.5 years, and a year later he was placed on the waiting list for a kidney transplant.
“This is my fifth visit to the clinic, because during the first four times the donor organs were not the most suitable for me,” says the patient. – And this time I drove thinking that maybe sometimes it would be like that. But this time luck! The idea that a kidney donor was sick with a fighter didn’t scare me at all. And I contracted this infection during the second wave, I had antibodies. “Now the man thinks that life will change beyond recognition, he is happy and wants to see his four-year-old son as soon as possible.
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