Incidence and Outcomes of Covid-19 Disease among Transplant Recipients and Operation Theatre Stuffs in Bangladesh

This chapter aims to find out the incidence and outcomes of COVID-19 disease among transplant recipients and operation theatre stuffs with short term outcomes of graft function by implementing a modified strategy. The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; previously provisionally named 2019 novel coronavirus or 2019-nCoV) disease (COVID-19) in China at the end of 2019 has caused a large global outbreak and is a major public health issue.

We retrospectively analyzed the data of 300 transplant recipients who underwent renal transplantation during this pandemic along with total 18 members of operation theatre staffs. Patients who were asymptomatic and biochemically and radiologically negative for COVID-19 disease were chosen for surgery. Prior to surgery, no patients or operating room personnel performed RT-PCR (reverse transcription-polymerase chain reaction) for COVID-19 tests. Any member of the surgical team or transplanted patient who acquired COVID-19 disease signs was assessed by a specialist and treated accordingly. The incidence of COVID-19 among patients and operating room personnel, as well as their outcomes and early graft function outcomes, were documented.

In this study, we have emphasized pre-operative screening for selection of patients and tried preventive strategies to prevent COVID-19 transmission. RT-PCR test COVID-19 was not performed in any of the patient or health care personnel. Since the introduction of novel coronavirus, the role of asymptomatic carriers in spreading the disease has remained a topic of discussion. Out of 300 recipients, none developed symptoms of COVID-19 during hospital stay before discharge. Total of 18 (6%) patients presented with symptoms of COVID-19 disease during first 4 weeks of discharge, out of them 10 (55.55%) were RT-PCR for COVID-19 positive and 2 (20%) COVID-specific deaths were observed in ICU. Among operation theatre staffs, 3 (16.67%) were confirmed as COVID-19 positive and cured in home isolation. There were total of 7 (2.33%) deaths due to COVID-19 and other complications.

Although recipients had a substantially lower incidence of COVID-19 infection than the general population, they also have a significantly greater mortality rate. This study aims to raise the issue of whether a more flexible but workable approach should be used in place of the rigid surgical recommendations of Covid-19 during kidney transplantation.