Consensus statement on organ donation from COVID-positive deceased donors-Indian Society of Organ Transplantation, Liver Transplant Society of India and Indian Society for Heart and Lung Transplantation

COVID has drastically impacted organ donation across the world, leading to untold misery for thousands of patients who have been waiting for organs. Early rules on the use of organs from COVID positive or affected donors were stringent due to the fear of spread of disease or thrombotic complications in patients who received these organs. However much has changed in the past two years. Most of our adult population has either been infected with COVID, or has received two doses of vaccine, or both. The current variant, despite being more infective, is associated with mild disease, especially in those who have been vaccinated Our armamentarium against severe COVID has improved dramatically in the past year- we have effective vaccines, monoclonal antibodies for treatment of mild COVID in high risk patients and post exposure and antiviral prophylaxis and treatment which can substantially reduce the risk of severe COVID requiring ICU admission. The risk of transmission of COVID infection has to be balanced against the risk of patients dying with end organ disease. We will have to learn to live with COVID- this also means investigating whether organs from donors who are, or have been COVID positive can be used with acceptable risk -benefit in selected patients with end stage organ failure. This document is a summary of evidence and information regarding donor screening for SARS-CoV-2 and considerations for organ acceptance from donors with a history of COVID-19.

Kawasaki disease in children with apparent increase in occurrence of incomplete and atypical forms

Background: Kawasaki disease (KD) is a common childhood vasculitis. Recent studies have shown an increase in proportions of children diagnosed with incomplete KD. Methods: Case records of 16 children with KD, registered from July 2019 to December 2020 in the department of pediatrics, Indira Gandhi Medical College, Shimla, India, were reviewed. Four children who had Kawasaki-like disease associated with Coronavirus disease 2019 were excluded from the study. Results: Sixteen children (11 boys, 5 girls;mean age 4.5 years) had KD. Eight (50%) children had incomplete KD. Fever (100%), oral changes (81.2%), rash (69%), desquamation (62.55), conjunctival injection (56.2%) and arthritis (31.2%) were common clinical features. Laboratory investigations showed neutrophilic leucocytosis (10/16), thrombocytosis (10/16), elevated erythrocyte sedimentation rate (12/16) and C-reactive protein (13/16). Six (37.5%) children had cardiac abnormalities. Three children had coronary artery aneurysms. Two children had pericardial effusion and 1 child had myocardial dysfunction. 14/16 children received intravenous immunoglobulin (IVIG). Two children received methylprednisolone pulse (30 mg/kg) followed by tapering dosages of prednisolone and 1 child was given injection infliximab (5 mg/kg), in addition to IVIG. Discussion: Fifty percent children in our cohort had incomplete KD and few children had atypical presentation. One child with KD had concomitant chicken pox. Another child had overlap of KD with HSP and 3 rd child developed insulin dependent diabetes mellitus (IDDM) 1 month after having KD. Five children in our cohort had arthritis. As compared to previous study from our centre, we found that KD is the most common childhood vasculitis at our centre with apparent increase in its occurrence and increase in the proportion of children with incomplete and atypical KD over the time. Conclusion: KD is the most common childhood vasculitis in our centre and apparent increase in its occurrence may be due to increased awareness and diagnosis of incomplete/atypical KD.

SOT Consensus Statement for the Kidney Transplant Recipient and Living Donor with a Previous Diagnosis of COVID-19

The National Organ and Tissue Transplant Organization (NOTTO) has previously published transplant-specific guidelines with reference to COVID-19.([1]) The mortality is higher in dialysis patients with COVID-19 (12%-30%) than posttransplant COVID-19 patients (11.3%) and both are higher than the general population (<2%) in India.([2-5]) With the resumption of the kidney transplant program in various parts of India, new issues are expected to occur. There is uncertainty, regarding the safety of performing kidney,([ 6-8]) liver,([9-12]) and lunge([13]) transplantation in a recipient recently recovered from COVID-19. At present, we have limited evidence-based information about safety and feasibility of kidney transplantation from living donors, who have recovered from COVID-19.([4]) Recently, Indian Multi-center cohort studies have reported successful kidney transplantation in recipients from living donors with a previous diagnosis of COVID-19.([15, 16])

Notto covid-19 vaccine guidelines for transplant recipients

In December 2019, novel coronavirus (SARS-CoV-2) infection started in Wuhan and resulted in a pandemic within a few weeks' time. Organ transplant recipients being at a risk for more severe COVID-19 if they get SARS CoV-2 viral infection, COVID-19 vaccine has a significant role in these patients. The vaccine is a safer way to help build protection and would either prevent COVID-19 infection or at least diminish the severity of the disease. It would also reduce the risk of the continuing transmission and enhance herd immunity. Immuno-compromised patients should not receive live vaccines as they can cause vaccine-related disease and hence the guidelines suggest that all transplant recipients should receive age-appropriate 'inactivated vaccine' as recommended for general population. Though trials have not been undertaken on transplant recipients, efficacy and safety of COVID-19 vaccine have been scientifically documented for few vaccines among the general population.

NOTTO COVID-19 vaccine guidelines for transplant recipients

In December 2019 Novel corona virus (SARS-CoV-2) infection started in Wuhan and resulted in a pandemic within few weeks' time. Organ transplant recipients being at a risk for more severe COVID-19 if they get SARS CoV-2 viral infection, COVID 19 Vaccine has a significant role in these patients. The vaccine is a safer way to help build protection and would either prevent COVID -19 infection or atleast diminish the severity of the disease. It would also reduce the risk of the continuing transmission and enhance herd immunity. Immuno compromised patients should not receive live vaccines as they can cause vaccine related disease and hence the guidelines suggest that all transplant recipients should receive age appropriate 'inactivated vaccine' as recommended for general population. Though trials have not been undertaken on transplant recipients, efficacy and safety of COVID-19 vaccine have been scientifically documented for few vaccines among the general population. © 2021 Indian Journal of Transplantation ;Published by Wolters Kluwer - Medknow.