ABSTRACT
Purpose: Transplantation of kidneys from donors with active SARS-CoV-2 infection is uncommon due to concerns about the risk of viral transmission and kidney quality. To date, there is no conclusive data that viral transmission from extra-pulmonary solid organ transplant is a possibility. Given the prevalence of SARS-CoV-2 infections in potential donors, the shortage of kidneys available for transplantation and the low risk of viral transmission, we developed a clinical protocol for accepting kidneys from donors with active SARS-CoV-2 infection and preserved kidney function. Method(s): Retrospective chart review of 5 kidney transplant recipients from 4 deceased donors with severe SARS-CoV-2 infection. Donor and recipient characteristics are reported using descriptive characteristics. Result(s): Donor creatinine ranged from 0.51 to 0.60 mg/dL and KDPI ranged from 14% to 52%. Three of the 5 kidneys came from donation after circulatory death donors. All recipients were fully vaccinated, and 4/5 received post-exposure prophylactic monoclonal antibody treatment. 3 recipients had delayed graft function but were off of dialysis by postoperative day 6 or 8. 3 recipients were readmitted, one for fluid overload and mild rejection on two different occasions, one for hypotension from dehydration and one for sepsis secondary to an aspiration pneumonia. The latter recipient subsequently died with a functioning graft secondary to a severe bacterial infection. This recipient was also found to have a femoral DVT during readmission on the contralateral side to the kidney graft. At 30 days post-transplant, no recipients displayed signs or symptoms of SARS-CoV-2 infection and the three who were readmitted tested negative for SARS-CoV-2 via nasopharyngeal swab. All had a creatinine less than 2 at the most recent follow up. Conclusion(s): Our findings suggest that kidney grafts from donors with severe SARSCoV- 2 infection but preserved kidney function can be safely used and have good early outcomes. However, more research is needed to determine the safety and long term outcomes of kidney transplantation from donors with severe COVID-19 pneumonia.
ABSTRACT
Objectives: The mainstay of care in severe traumatic brain injury (TBI) includes time-critical delivery of effective medical and surgical interventions. This is streamlined by Code Black trauma calls at our Major Trauma Centre (MTC). The Covid- 19 pandemic placed unprecedented strain on resources within healthcare and the wider society. The aim of this study was to analyse its effects on the presentation and management of time-critical TBI. Design: Retrospective analysis of the prospective database. Subjects: Patients with severe TBI who triggered Code Black trauma calls from January 2019 until December 2020. Code Black is activated by Glasgow Coma Scale (GCS) ≤ 8, severe mechanism of injury, and changes in pupillary reactivity. Methods: Demographics, clinical, radiological, and surgical findings were collected from medical records and the Trauma and Audit Research Network (TARN);socioeconomic data from the Office for National Statistics. We compared 2019 to the pandemic in 2020. Results: There were 58 and 62 Code Black activations, respectively in 2019 and 2020. During the pandemic, more patients were male (83.9 vs. 65.5%, p = 0.02), and more injuries alcohol-related (33.9 vs. 19.0%) and intentional (19.4 vs. 8.6%). The hospital stay was shorter (21 vs. 32 d). The index of multiple deprivations (IMD) was one decile lower in 2020 (p = 0.036). The mechanism, severity, intracranial findings, timeliness of care, and mortality remained unchanged. Surgical intervention was performed in two-thirds of patients and was associated with higher survival (68.0%) vs. non-surgical treatment (40.0%, p = 0.003). Predictors of in-hospital mortality included increasing age, injury severity, and pupillary changes. Conclusions: The Covid-19 pandemic brought a change to the pattern of time-critical TBI and disproportionately affected lower socioeconomic groups. Although the volume of work remained unchanged, we maintained high-quality care throughout. This highlights the need to retain trauma services during the Covid-19 pandemic.