Single centre experience of paediatric intestinal transplantation during the COVID-19 pandemic: Lessons from adapting to pandemic pressures

ABSTRACT

Introduction: The COVID-19 pandemic has created challenges for centres performing solid organ transplantation especially with the limited availability of donors, including restrictions related to lockdowns. We aimed to assess the impact of the measures and steps taken to mitigate these challenges in order to continue to deliver intestinal/multivisceral transplantation (I/MVTx). Methods: All I/MVTx between March 2020 to December 2020 were included in the study. Data were collated from a prospectively maintained departmental database and are presented descriptively. Results: All potential I/MVTx recipients were suspended at the start of the pandemic and were reactivated after an eight week period of risk assessment. A total of five transplants were performed during the study period. (Table-1) All recipients and donors were COVID tested just prior to surgery and managed through a COVID clean patient pathway as per NHSBT. Discussion: Pre-operative precautions (screening of donor history, additional endotracheal swabs and recipient swabs) were in place at the time of the procedures. Clinical urgency mandated conscious decisions such as liver reduction and staged abdominal closure in two patients with intractable GI bleeding. Intra-operative risk mitigation strategies included utilisation of standard PPE, minimal personnel in theatre and minimisation of surgical pauses. The prioritisation of the procedures to experienced donor and recipient surgeons allowed for short Cold ischemia times (some recipient operations were started prior to cross clamp at the donor site). No changes were made to immunosuppression protocols. Post-operative follow up was changed to minimize recipient visits to the hospital. There were no routine follow up endoscopies and stomal biopsies were reduced to once-a-week and when clinically indicated. No routine follow up face-to-face outpatient appointments were made. Instead, parents were educated and supported through a process of daily weight and stoma output monitoring and these were directly reported to the consultant through e-mail. Conclusion: Adaptation to different challenges during the pandemic permitted restitution of the intestinal transplant pathway without any deleterious effect on outcomes. Changes in post discharge practice introduced will continue and may improve the patient care pathway.