Living Donor Kidney Transplantation During The COVID-19 Pandemic: A Single Center Experience

Öz

Objective: Due to the COVID-19 pandemic, renal transplantation operations were either stopped or restricted to be performed in selected patient groups in many centers globally. When evaluated together with the kidney transplantation process surgery and immunosuppression therapy applied in the postoperative period, it is a complex procedure, and requires close follow-up. The purpose of our study; to present the renal transplantation operations that performed during the pandemic process, the pre-operative preparation of the patients, the post-operative follow-up processes, and applied treatment approaches.
Method: Renal transplantation operations which are performed in our transplant center during the pandemic were evaluated retrospectively. The demographic characteristics of the recipients and donors, graft function tests, COVID-19 PCR results, HLA matches, hot-cold ischemia times and post-transplantation complications were recorded. As induction therapy, the patients were divided into two groups as Group 1 with antithymuside globulin (ATG), and Group 2 with Basiliximab. The groups were evaluated in terms of preoperative and postoperative day 1, day 7, and 1st month serum creatinine levels, ATG cumulative level and HLA compatibility.
Results: Twenty-two kidney transplantations were performed in our center between March 2020 and November 2020. Living donor kidney transplantation was performed in 21 patients. There were 7 female and 14 were male patients. The mean age of the patients was 41.95 ± 15.11 years and the body mass index was 26.37 ± 5.04 kg / m2. As induction therapy, ATG was applied to 7 patients and basiliximab to 13 patients. Induction therapy was not applied to one patient with full compliance. There was no statistically significant difference between the two groups in terms of early acute rejection or graft dysfunction for any reason (p> 0.05). COVID-19 infection developed in 3 patients within a 6-month postoperative period.
Conclusion: During the pandemic period when the frequency of transmission is decreasing kidney transplantation operations can be performed at low intensity in experienced centers under close follow-up and strict isolation measures during periods

Anahtar Kelimeler

• Kidney transplantation
• chronic renal disease
• laparoscopic donor nephrectomy
• COVID-19
• induction therapy

COVID-19 Pandemisi Sırasında Canlı Donör Böbrek Nakli: Tek Merkez Deneyimi

Öz

Amaç: COVID-19 pandemisi nedeniyle global düzeyde pek çok merkezde böbrek nakli operasyonları ya durdurulmuş yada seçilmiş hasta gruplarında yapılmak üzere kısıtlamaya gidilmiştir. Böbrek nakil süreci, cerrahisi ve postoperatif dönemde uygulanan immünosüpresyon tedavisi ile birlikte değerlendirildiğinde karmaşık ve yakın takip gerektiren bir uygulamadır. Çalışmamızın amacı; pandemi sürecinde yaptığımız nakil operasyonlarını, hastaların operasyon öncesi hazırlık, operasyon sonrası takip süreçlerini ve uyguladığımız tedavi yaklaşımlarını sunmaktır. Yöntem : Pandemi süresince nakil merkezimizde gerçekleştirilen böbrek transplantasyonu operasyonları retrospektif olarak değerlendirildi. Alıcı ve vericilerin demografik özellikleri, greft fonksiyo testleri, COVID-19 PCR sonuçları, HLA uyumları, sıcak-soğuk iskemi süreleri ve nakil sonrası görülen komplikasyonları kaydedildi. İndüksiyon tedavisi olarak hastalar antitimusit globülin (ATG) uygulanan Grup 1 ve Basiliksimab uygulananlar Grup 2 olmak üzere iki gruba ayrıldı. Gruplar preoperatif ve postoperatif 1. Gün 7. Gün ve 1. Ay serum kreatinin düzeyleri, ATG kümülatif düzeyi, HLA uyumları açılarından değerlendirildi. Bulgular: Merkezimizde Mart 2020 Kasım 2020 tarihleri arasında 22 böbrek nakli operasyonu gerçekleştirildi. 21 hastaya canlı vericili böbrek nakli uygulandı. Hastaların 7’si kadın 14’ü erkekti. Hastaların ortalama yaşı 41,95±15,11 yıl ve vücut kitle indeksi 26,37±5,04 kg/m2 idi. İndüksiyon tedavisi olarak hastaların 7’sine ATG, 13‘üne basiliksimab uygulandı. Tam uyum olan bir hastaya indüksiyon tedavisi uygulanmadı. Erken dönemde akut rejeksiyon veya herhangi bir nedenle greft disfonksiyonu açısından istatistiksel olarak iki grup arasında anlamlı fark yoktu (p>0.05). Sonuç: Pandemi döneminde bulaş sıklığının azaldığı dönemlerde yakın takip ve sıkı izolasyon tedbirleri altında deneyimli merkezlerde böbrek nakli operasyonları düşük yoğunlukta yapılabilir. Living Donor Kidney Transplantation During The COVID-19 Pandemic: A Single Center Experience Abstract Objective: Due to the COVID-19 pandemic, renal transplantation operations were either stopped or restricted to be performed in selected patient groups in many centers globally. When evaluated together with the kidney transplantation process surgery and immunosuppression therapy applied in the postoperative period, it is a complex procedure, and requires close follow-up. The purpose of our study; to present the renal transplantation operations that performed during the pandemic process, the pre-operative preparation of the patients, the post-operative follow-up processes, and applied treatment approaches. Method : Renal transplantation operations which are performed in our transplant center during the pandemic were evaluated retrospectively. The demographic characteristics of the recipients and donors, graft function tests, COVID-19 PCR results, HLA matches, hot-cold ischemia times and post-transplantation complications were recorded. As induction therapy, the patients were divided into two groups as Group 1 with antithymuside globulin (ATG), and Group 2 with Basiliximab. The groups were evaluated in terms of preoperative and postoperative day 1, day 7, and 1st month serum creatinine levels, ATG cumulative level and HLA compatibility. Results: Twenty-two kidney transplantations were performed in our center between March 2020 and November 2020. Living donor kidney transplantation was performed in 21 patients. There were 7 female and 14 were male patients. The mean age of the patients was 41.95 ± 15.11 years and the body mass index was 26.37 ± 5.04 kg / m2. As induction therapy, ATG was applied to 7 patients and basiliximab to 13 patients. Induction therapy was not applied to one patient with full compliance. There was no statistically significant difference between the two groups in terms of early acute rejection or graft dysfunction for any reason (p> 0.05). Conclusion: During the pandemic period when the frequency of transmission is decreasing kidney transplantation operations can be performed at low intensity in experienced centers under close follow-up and strict isolation measures during periods Keywords: Kidney transplantation, chronic renal disease, laparoscopic donor nephrectomy, COVID-19, induction therapy

Anahtar Kelimeler

• Böbrek nakli
• Kronik böbrek yetmezliği
• Laparoskopik donör nefrektomi
• COVİD-19
• İndüksiyon tedavisi

Kaynakça

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