Challenges Facing Transplant Patients in COVID-19 Era

Transplant patients have an increased risk of developing severe illness when infected with the novel coronavirus. Reports indicate a mortality rate of up to 28% among solid organ transplant patients hospitalized with coronavirus disease 2019 (COVID-19).¹

Among the challenges that transplant recipients face is the drug-drug interactions associated with COVID-19 treatment and concomitant medications. For example, remdesivir increases the level of transaminase, which requires close monitoring of liver markers with transplant patients.¹

Another challenge is the lack of a test that is sensitive enough to detect active COVID-19-infected donors prior to transplant. Therefore, it’s important to counsel solid organ donors to avoid crowds and monitor exposure for 14 days prior to transplant, whereas hematopoietic cell donors should avoid the crowd for 28 days prior to the scheduled transplant.¹

Heart transplant patients are facing more challenges during COVID-19. Most of these patients are waiting inside the hospital to receive a heart transplant, which increases their risk of contracting the virus, developing severe complications, and risking delisting.² All transplant centers should inform candidates about the wait list mortality risk—benefit ratio and provide updates by directly contacting their patients.²

Many hospitals are implementing strategies to preserve intensive care unit beds, staffing, and medical equipment for non-transplant population.² For example, most of the heart transplant candidates have waiting lists that are restricted to patients with a wait list mortality of 1 to 2 weeks.² In addition, the restriction of endomyocardial biopsies can increase the risk of having patient misdiagnosed for rejection, while presenting manifestation of myocarditis.²

Transplant patients should take preventative measures, that include patient/family hygiene and social distancing.² Based on CDC recommendations, transplant patients should not stop or change medications without consulting their physician.³ It’s prudent to have at least a 30-day supply of medications in case patients are required to stay home for a couple days/weeks.

As many questions remain, the available knowledge about the virus and its effects on special populations is rapidly evolving.²

REFERENCES

• NIH. Special Considerations in Solid Organ Transplant, Hematopoietic Stem Cell Transplant, and Cellular Therapy Candidates, Donors, and Recipients. https://www.covid19treatmentguidelines.nih.gov/special-populations/transplant/ . Accessed December 7, 2020.
• AHA Journals. Challenges in Heart Transplantation in the Era of COVID-19. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.047096 . Accessed December 7, 2020.
• CDC. If You Are Immunocompromised, Protect Yourself From COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/immunocompromised.html. Accessed December 11, 2020.