Doctors are gradually returning to risky but life-saving procedures such as organ transplants as hospitals learn to function around Covid-19. In Jaslok hospital, doctors treated two kidney transplant recipients who contracted Covid-19 after surgery. In Nanavati hospital, four live liver transplants have taken place in last three months. On Sunday, an Ahmedabad resident with chronic liver disease underwent a liver transplant in an emergency procedure there.
The new organ transplant guidelines advise doctors to test donor and recipient for Covid-19 twice in a gap of five days and then conduct transplantation. In emergency case a single Covid-19 is permitted.
In Jaslok hospital, a 35-year-old man and another 45-year-old man underwent kidney transplant in March, and both contracted Covid-19 post surgery within days. “One was discharged and he returned for hospitalisation with Covid-19. We decided to lower the dose of immunosuppressants so that body immunity can fight the coronavirus,” said Dr M M Bahadur, Director of Department of Nephrology and Transplant in Jaslok.
Post-transplant patients are put on immunosuppressants— medication that lowers their immunity — and remain at risk of severe Covid-19 infection for months. Immunosuppressants are important for transplant patients, as they help the body accept a foreign organ preventing the immunity system from rejecting it. This is why the immunosuppressants dosage in the two Jaslok patients was lowered, to first fight coronavirus.
Both patients recovered from Covid-19 and have health kidney functions now. The case studies are slated to be published in American Journal of Transplantation. Bahadur said that available world literature of transplant patients contracting Covid-19 is limited.
According to him, five patients in New York, London and Wuhan, who underwent an organ transplant, later caught Covid-19 and suffered severe complications. Two of them died in New York and other two remained under prolonged hospitalisation in London.
Until now, transplant surgeons have been postponing routine transplants.
“For liver failure there is no therapy to prolong life span, unlike kidney patients who can be put on dialysis. In some cases we have to conduct liver transplants,” said Dr Ankur Garg, liver transplant surgeon in Nanavati hospital. The hospital has done four liver transplants in last three months. Doctors said extra care is taken to ensure the transplant team is Covid free. All nurses, doctors, staffers are tested along with recipient and donor to avoid infection risk. “There is risk of infection from us to patient and from patient to us. We wear personal protective equipment and disinfect everything,” Garg said.
On Sunday, an Ahmedabad resident had to be transported in a cardiac ambulance to Mumbai for urgent transplantation. He was admitted in intensive care unit and also required dialysis support. “We did a Covid test on him and his wife, conducted a CT scan, and took them for surgery. The wife donated her liver. Depending on their health, they will be kept for 10-12 days,” Garg said.
Dr Astrid Lobo, director of Regional Organ and Tissue Transplant Organisation, said there is more clarity on how to conduct an organ transplant after the Centre and state issued guidelines. “Earlier doctors were scared, now they have clarity. There are standard operating protocols that each hospital needs to follow. We are seeing a slow rise in organ transplants now,” Lobo said.
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