Practicing With Uncertainty: Kidney Transplantation During the COVID-19 Pandemic

Area of Science:

• Nephrology
• Transplant Surgery
• Infectious Diseases

Background:

• The COVID-19 pandemic presented unprecedented challenges for kidney transplant programs, necessitating rapid adaptation of clinical practices.
• Initial responses included reduced transplant volumes and a halt in living donor procedures due to uncertainty and safety concerns.

Purpose of the Study:

• To reflect on practice decisions made by the transplant community during the early COVID-19 pandemic.
• To analyze lessons learned regarding deceased-donor and living-donor transplantation.
• To review therapeutic strategies, immunosuppression, and vaccination for SARS-CoV-2 in transplant recipients.

Main Methods:

• A perspective piece reflecting on clinical experiences and decision-making during the pandemic.
• Review of evolving data and consensus guidelines on managing transplant patients with SARS-CoV-2 infection.
• Discussion of logistical considerations and risk-benefit analyses for transplant procedures.

Main Results:

• Significant initial reduction in kidney transplant procedures and living donation.
• Rapid adoption of telehealth for patient evaluation and follow-up.
• Ongoing learning and adaptation of strategies for managing SARS-CoV-2 in transplant recipients.

Conclusions:

• The pandemic necessitated critical decisions regarding transplant operations, with ongoing uncertainty in some areas.
• Experience gained informs current practices, including managing SARS-CoV-2 infection and considering vaccination.
• Future research priorities are identified to address remaining questions and prepare for the next phase of the pandemic.