Transplant programmes in areas with high SARS-CoV-2 transmission.

We read Alexandre Loupy and colleagues' account of a significant reduction in transplant activity in France and the USA with interest. The UK also has a high burden of COVID-19 with high severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission leading to a significant reduction in organ donation and transplant activity. In the UK, in April, 2020, only five out of 23 kidney transplant centres were active during lockdown. According to NHS Blood and Transplant, on May 8, 2020, deceased-donor organ retrieval was down by 63% and kidney transplantation by 57% compared with 2019.

The Oxford Transplant Centre is located in a hospital without an emergency department and is maintained as a COVID-19-free site—any suspected cases are isolated on a designated ward, and if confirmed are rapidly transferred to the main acute hospital. We have made profound system-wide changes to our practice covering donor and recipient selection, hospital logistics, and perioperative management to enable our transplant programme to continue, which are summarised in the appendix (pp 1–2). These changes have been highly effective. Between March 16 and May 12, 2020, we did 38 deceased-donor kidney transplants—27 from donation after brain death and 11 from donation after cardiac death. This compares with 16 kidney-alone transplants for the same period in 2019, a rise secondary to an increase in the number of offers as other transplant centres have closed. Follow-up times for these 38 transplants are 1–58 days; we have at least 7 days of follow-up for 31 cases. Initial results are reported here and summarised in the appendix. Median length of hospital stay was 5 days. 9 (29%) of 31 patients had delayed graft function, defined as any use of postoperative dialysis. All discharged patients are no longer dialysis dependent. During this short-term follow-up period none of these recipients have contracted SARS-CoV-2. Three were readmitted to hospital—one for peritoneal dialysis catheter related peritonitis, and two for management of diabetes.

COVID-19 appears to be more prevalent in the UK haemodialysis population than the UK transplant population (8·6% vs 1·1%) with comparable mortality risk (22·5% vs 25·1%)—summarised in the appendix (p 5). Our early results support the notion that a continued (albeit radically altered) transplant programme helps minimise pandemic risk in a highly vulnerable population. Soon transplant services might need to coexist with COVID-19 and, much as previous generations did in an earlier era of infectious disease, we will need to learn to segregate patients who are at risk.