The hamletic dilemma of patients waiting for kidney transplantation during the COVID-19 pandemic: To accept or not to accept (an organ offer)?

Tommaso M Manzia, Roberta Angelico, Luca Toti, Gennaro Pisani, Giuseppe Vita, Francesca Romano, Brunella M Pirozzi, Danilo Vinci, Roberto Cacciola, Giuseppe Iaria, Giuseppe Tisone, Tommaso M Manzia, Roberta Angelico, Luca Toti, Gennaro Pisani, Giuseppe Vita, Francesca Romano, Brunella M Pirozzi, Danilo Vinci, Roberto Cacciola, Giuseppe Iaria, Giuseppe Tisone

Abstract

The outbreak of COVID-19 led to a reduction in the number of organ transplant interventions in most Countries. In April 2020, at the Tor Vergata University in Rome, Italy, two patients on the waiting list for kidney transplantation (KT) declined a deceased donor's kidney offer. Therefore, between April 20 and 25, 2020, we conducted a telephone survey among our 247 KT waitlist patients. Our aim was to explore: (a) the COVID-19 diffusion among them and (b) their current willingness to be transplanted in case of a kidney offer from a deceased donor. Two hundred and forty-three patients participated in a phone interview. One patient had died from COVID-19. Eighty-five (35%) KT candidates would decline any kidney offer, in most cases until the end of the COVID-19 pandemic. Upon a multivariate analysis, female gender (OR = 2.25, 95% CI = 1.26-4.03, P = .006), high cardiovascular risk (OR = 2.33, 95% CI = 1.06-5.08, P = .034), a waiting list time <3 years (OR = 0.375, 95% CI = 0.15-0.95, P = .04), and the need to be transferred to another hospital for HD (OR = 2.56, 95% CI = 1.10-5.9, P = .03) were associated with such refusal. The COVID-19 pandemic led to a fear of transplantation in a third of the KT candidates. Proactive educational webinars could be a useful tool to remove, or at least lessen, any doubts on the part of KT candidates and to avoid losing the opportunity to quit dialysis.

Keywords: COVID-19; SARS-CoV-2; deceased donor; kidney transplantation.

Conflict of interest statement

The authors have declared no conflict of interest.

© 2021 Wiley Periodicals LLC.

References

    1. World Health Organization . Coronavirus disease (COVID‐19) pandemic. . Accessed November 11, 2020.
    1. World Health Organization . Novel Coronavirus (COVID‐19) situation reports. . Accessed November 11, 2020.
    1. Italian Government Measures . Legislative decree for COVID‐19 emergency March 8, 2020, n. 59. . Accessed November 11, 2020.
    1. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507‐513.
    1. Wang D, Hu BO, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061‐1069.
    1. Yan Y, Shin WI, Pang YX, et al. The first 75 Days of novel coronavirus (SARS‐CoV‐2) outbreak: recent advances, prevention, and treatment. Int J Environ Res Public Health. 2020;17(7):2323.
    1. Italian National Transplant Centre . . Accessed November 11, 2020.
    1. Boyarsky BJ, Chiang TP, Werbel WA, et al. Early impact of COVID‐19 on transplant center practices and policies in the United States. Am J Transplant. 2020;20(7):1809‐1818.
    1. Organ Procurement and Transplantation Network . . Accessed May 1, 2020.
    1. Klarić M, Letica I, Petrov B, et al. Depression and anxiety in patients on chronic hemodialysis in University Clinical Hospital Mostar. Coll Antropol. 2009;33(suppl 2):153‐158.
    1. Wang C, Pan R, Wan X, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID‐19) epidemic among the general population in China. Int J Environ Res Public Health. 2020;17(5):1729.
    1. Bertakis KD, Azari R, Helms LJ, et al. Gender differences in the utilization of health care services. J Fam Pract. 2000;49(2):147‐152.
    1. American Society of Transplantation . Coronavirus Disease 2019 (COVID‐19): Frequently Asked Questions from Transplant Candidates and Recipients. . Accessed November 11, 2020.
    1. Kato S, Chmielewski M, Honda H, et al. Aspects of immune dysfunction in end‐stage renal disease. Clin J Am Soc Nephrol. 2008;3(5):1526‐1533.
    1. Alberici F, Delbarba E, Manenti C, et al. Management of patients on dialysis and with kidney transplant during SARS‐COV‐2 (COVID‐19) pandemic in Brescia, Italy. Kidney Int Rep. 2020;5(5):580‐585.
    1. Watnick S, McNamara E. On the frontline of the COVID‐19 outbreak. Keeping patients on long‐term dialysis safe. Clin J Am Soc Nephrol. 2020;15(5):710‐713.
    1. Yiqiong M, Bo D, Xifeng L, et al. 2019 novel coronavirus disease in hemodialysis (HD) patients: Report from one HD center in Wuhan, China. . Accessed May 10, 2020.
    1. Italian National Transplant Centre . . Accessed November 11, 2020.
    1. Angelico R, Trapani S, Manzia TM, et al. The COVID‐19 outbreak in Italy: initial implications for organ transplantation programs. Am J Transplant. 2020;20(7):1780‐1784.
    1. Italian National Transplant Centre . . Accessed November 11, 2020.
    1. Martino F, Plebani M, Ronco C. Kidney transplant programmes during the COVID‐19 pandemic. Lancet Respir Med. 2020;8(5):e39.
    1. Italian National Transplant Centre . . Accessed November 11, 2020.
    1. Maggi U, De Carlis L, Yiu D, et al. The impact of the COVID‐19 outbreak on Liver Transplantation programmes in Northern Italy. Am J Transplant. 2020;20(7):1840–1848.
    1. Mehta P, McAuley DF, Brown M, et al. COVID‐19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033‐1034.
    1. . Accessed November 11, 2020.
    1. . Accessed November 11, 2020.
    1. Parente A, Manzia TM, Angelico R, et al. COVID‐19, liver transplant, and immunosuppression: allies or foes? Transpl Infect Dis. 2020;23(1):e13417.
    1. Monaco A, Manzia TM, Angelico R, et al. Awareness and impact of non‐pharmaceutical interventions during coronavirus disease 2019 pandemic in renal transplant recipients. Transplant Proc. 2020;52(9):2607‐2613.
    1. Logunov DY, Dolzhikova IV, Zubkova OV, et al. Safety and immunogenicity of an rAd26 and rAd5 vector‐based heterologous prime‐boost COVID‐19 vaccine in two formulations: two open, non‐randomised phase 1/2 studies from Russia. Lancet. 2020;396(10255):887‐897.
    1. Zhu FC, Li YH, Guan XH, et al. Safety, tolerability, and immunogenicity of a recombinant adenovirus type‐5 vectored COVID‐19 vaccine: a dose‐escalation, open‐label, non‐randomised, first‐in‐human trial. Lancet. 2020;395(10240):1845‐1854.
    1. . Accessed November 11, 2020.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe