COVID-19BOLETIM RAMB

Número 30 15 de setembro de 2020

Should kidney transplants during the COVID-19 pandemic be canceled or maintained?Germano José Ferraz de ArrudaJerônimo Ferraz de Arruda NetoLuís Cesar Fava SpessotoJosé Germano Ferraz de ArrudaFernando Nestor Fácio Jr.

BOLETIM RAMB COVID-19 • NÚMERO 30 > > > 2

Em um momento em que há uma emergência mundial de saúde pública, é fundamental que o conhecimento científico ge-rado durante a pandemia chegue rapidamente à classe médica classe médica.

Dentro desta dinâmica a Revista da Associação Médica Brasi-leira (Ramb) está adotando uma série de medidas a fim de acelerar o processo editorial para publicação de artigos sobre a Covid-19. A partir de hoje (14/04/2020), a AMB publicará o Boletim Ramb Covid-19, que antecipará os artigos científicos selecionados pelos editores da Ramb sobre o tema.

“Os artigos foram escritos por especialistas e selecionados den-tro dos critérios da Ramb para esclarecer temas fisiopatológicos, assim como oferecer orientações de prevenção e tratamento da doença. Dessa forma, esperamos colaborar com os médicos para o melhor atendimento aos seus pacientes, com a disponibilidade mais ágil desses artigos, antes de sua publicação na Ramb”, co-menta Carlos Serrano Jr., editor-chefe da Ramb.

Para o diretor científico da AMB, Antonio Carlos Palandri Cha-gas, “neste momento ímpar vivido no mundo por conta da pan-demia de Covid-19, a AMB cumpre seu papel de estar levando à comunidade científica brasileira os recentes artigos sobre os mecanismos fisiopatológicos e aspectos clínicos relevantes dessa situação que assola a saúde pública”.

Antonio Carlos Palandri Chagas

Carlos Serrano Jr.

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BOLETIM RAMB COVID-19 • NÚMERO 30 > > > 5

Should kidney transplants during the COVID-19 pandemic be canceled or maintained?

Germano José Ferraz de Arruda1Jerônimo Ferraz de Arruda Neto2Luís Cesar Fava Spessoto3José Germano Ferraz de Arruda3 Fernando Nestor Fácio Jr.3

1. Mestrando do Curso de Ciências da Saúde, Faculdade de Medicina (FAMERP), São José do Rio Preto, SP, Brasil.2. Residente de Cirurgia Geral, Hospital São Domingos. Catanduva, SP, Brasil.3. Professor de Urologia, Departamento de Urologia. Faculdade de Medicina (FAMERP/FUNFARME), São José do Rio Preto, SP, Brasil.

the pandemic include scarcity of financial resources, lack of beds and respirators, exhaustion of health professionals, and difficulty in per-forming social distancing due to visits to dialysis centers three times per week. Factors that were already problematic in developing countries are now worse with the imminent collapse of the healthcare system. Patients in need of a transplant are more susceptible to COVID-19 due to exposure to the hospital setting, the use of immunosuppressants, and the presence of chronic comorbidities.

There are not yet recommen-dations for an optimized approach regarding infected immunosup-pressed patients. Kidney transplant patients affected by COVID-19 exhibit a broad clinical-laboratorial spec-trum of the disease4. There is no evi-dence to consider kidney transplant a completely safe procedure in areas affected by the pandemic.

SUMMARYKEYWORDS: Coronavirus Infections. Pandemics. Kidney Transplantation.

RESUMOPALAVRAS-CHAVE: Infecções por Coronavirus. Pandemias. Transplantes de rim.

COVID-19 is the disease caused by the new coronavirus (SARS-CoV-2) and constitutes a pandemic that has not been previously recorded. There are currently more than 3.5 million cases confirmed in more than 200 countries and more than 100 thou-sand cases in Brasil. Thus, there has been a shift in the priorities of healthcare services, with mate-rial and human resources directed towards the treatment of the infected population1. This has been particu-larly detrimental to patients with chronic diseases.

Chronic kidney disease is closely related to arterial hypertension and diabetes, both risk factors for a worse prognosis of COVID-19. Special attention should be given to this population regarding the measures of individual protection and social isolation recommended by healthcare authorities. Kidney transplants require special care, as

such patients are highly susceptible to this infection.

According to the American Society of Transplantation2, transplants with a live donor are not recommended during the pandemic and epidemi-ological, clinical, and laboratorial investigations should be performed for deceased donors. Regarding the recipients, the risk-benefit ratio of the procedure should be weighed, as both patients and the surgical team cur-rently run the risk of infection by the new coronavirus2. Moreover, infection by COVID-19 may not be diagnosed in donors and recipients due to the low sensitivity of the PCR analysis. An analysis of the bronchoalveolar lavage of the recipient can increase the accu-racy of the test, but the time between the notification and execution of the transplantation may render this diag-nostic test unfeasible3.

Challenges for transplant ser-vices and patients on dialysis during

https://orcid.org/0000-0003-4578-7698https://orcid.org/0000-0002-7917-7137https://orcid.org/0000-0002-4697-5757https://orcid.org/0000-0002-5739-3613https://orcid.org/0000-0002-0527-5623

BOLETIM RAMB COVID-19 • NÚMERO 30 > > > 6

DisclosureThe authors of this manuscript have no conflicts of interest to disclose. .

Brasil is a large country with dif-ferent stages of the epidemiological curve of the disease. Thus, each case should be considered according to the characteristics of the recipient, geographic location of the transplant center, and incidence of infection by COVID-19 in order to minimize the risks for the patient and medi-cal team. There are currently about 6000 kidney transplants performed annually and nearly 9000 patients on the waiting list5. Suspension of these

surgeries will lead to an accumula-tion of patients on the waiting list for dialysis, as resources at dialysis centers are limited. Despite so many uncertainties, kidney transplants should be maintained as long as the healthcare system permits in order to avoid the loss of donated organs and an increase in morbidity and mortal-ity rates of patients on the waiting list.

AcknowledgmentsFunding sources – None.

Submitted Date: 28-May-2020 Accepted Date: 02-Jun-2020

corresponding author: Germano José Ferraz de Arruda Av. Faria Lima, 5416, São José do Rio Preto, SP, Brasil – 15015-040E-mail: germano_lito@yahoo.com.br

REFERENCES1. Sharma S, Lawrence C, Giovinazzo F. Transplant programs during COVID-19: unintended consequences for health inequality. Am J Transplant. 2020. doi: 10.1111/

ajt.15931.2. American Society of Transplantation. COVID-19 (Coronavirus): FAQs for organ donation and transplantation. [cited 2020 May 23]. Mount Laurel: American Society

of Transplantation; 2020. Available from: https://www.myast.org/sites/default/files/COVID19%20FAQ%20Tx%20Centers%202020.03.11_FINAL.pdf3. Martino F, Plebani M, Ronco C. Kidney transplant programmes during the COVID-19 pandemic. Lancet Respir Med. 2020;8(5):e39.4. Banerjee D, Popoola J, Shah S, Ster IC, Quan V, Phanish M. COVID-19 infection in kidney transplant recipients. Kidney Int. 2020;97(6):1076-82.5. Associação Brasileira de Transplantes de Órgãos. Registro Brasileiro de Transplantes. São Paulo: Associação Brasileira de Transplantes de Órgãos; 2019. [cited 2020

May 23]. Available from: http://www.abto.org.br/abtov03/Upload/file/RBT/2019/RBT-2019-jan-set-leitura.pdf

mailto:germano_lito@yahoo.com.br