Published online Sep 18, 2020. doi: 10.5500/wjt.v10.i9.223
Peer-review started: May 11, 2020
First decision: May 20, 2020
Revised: May 23, 2020
Accepted: August 24, 2020
Article in press: August 24, 2020
Published online: September 18, 2020
Processing time: 128 Days and 1.1 Hours
Kidney transplantation at the time of a global viral pandemic has become challenging in many aspects. Firstly, we must reassess deceased donor safety (for the recipient) especially in communities with a relatively high incidence of coronavirus disease 19 (COVID-19). With respect to elective live donors, if one decides to do them at all, similar considerations must be made that may impose undue hardship on the donor. Recipient selection is also problematic since there is clear evidence of a much higher morbidity and mortality from COVID-19 for patients older than 60 and those with comorbidities such as hypertension, diabetes, obesity and lung disease. Unfortunately, many, if not most of dialysis patients fit that mold. We may and indeed must reassess our allocation policies, but this must be done based on data rather than conjecture. Follow-up routines must be re-engineered to minimize patient travel and exposure. Reliance on technology and telemedicine is paramount. Making this technology available to patients is extremely important. Modifying or changing immunosuppression protocols is controversial and not based on clinical studies. Nevertheless, we should reassess the need for induction therapy across the board for ordinary patients and the more liberal use of mammalian target of rapamycin inhibitors in transplant patients with proven infection.
Core Tip: Transplantation in areas with a high rate of the coronavirus disease 19 (COVID-19) infection may be risky for recipients, as there may be a risk of COVID-19 transmission from infected donors. All preventive measures should be taken while treating kidney transplant patients.