NICE guidance on kidney transplantation in the COVID-19 era: a summary

NICE has published guidelines on delivering kidney transplant services during the COVID-19 pandemic. Here, Univadis summarises key recommendations.

Service planning

1. Ensure COVID-19-secure areas for assessment, follow-up and ongoing care.

2. Ensure adequate access to:

• staff, facilities and equipment;
• rapid turnaround SARS-CoV-2 testing; and
• COVID-19-secure inpatient beds.

3. Consult NHS Blood and Transplant, commissioners and other centres on transferring services.

4. Minimise face-to-face contact by:

• using telephone, video or email consultations;
• cutting non-essential appointments;
• contacting patients via text message, telephone or email;
• using e-prescriptions; and
• using different methods to deliver prescriptions and medicines.

Communication

1. Direct patients, donors, families and carers to the following:

• Government guidance on mental health aspects of COVID-19;
• Kidney Care UK COVID-19 patient information;
• National Kidney Federation COVID-19 information for patients; and
• NHS Blood and Transplant coronavirus update.

2. Advise patients:

• Not to stop or change medications unless otherwise advised.
• Attend scheduled appointments and dialysis.
• Contact the team if they are unwell.
• Contact NHS 111 online coronavirus service if they think they have COVID-19 or 999 for emergencies.

3. If patients or potential donors need to attend face-to-face appointments, advise them to:

• follow government advice on social distancing; 
• attend with only one companion; and
• avoid public transport if possible.

Transplant recipients

1. Advise on shielding of vulnerable people.

2. Add positive patients to the central shielding list and inform their GP.s

3. Follow recommendations on infection prevention and control.

4. Consider less frequent blood monitoring for patients stable on immunosuppressants.

5. Patients on immunosuppressants may have atypical COVID-19 presentations, e.g. patient on prednisolone may not develop fever.

6. Modify therapy as per the British Transplantation Society and Renal Association guidance.

Deceased donors

1. Follow guidance on COVID‑19 screening in deceased donors.

Living donors

1. Do not start donation until the donor and recipient test negative for SARS-CoV-2.

2. Advise patients on:

• the implications of kidney donation in the context of COVID-19;
• mitigating risks; and
• delays to transplantation if they contract COVID-19.

3. Consult guidance on consent.

4. For donors self-isolating for known/suspected COVID-19 or because of close contact, defer donations until they have been symptom-free for ≥28 days and have a negative test.

5. Advise donors and household members to self-isolate for 14 days before transplant.

6. Assess donors for COVID-19 before scheduling and on admission.

Patients on the waiting list

1. Consider SARS-CoV-2 testing for asymptomatic patients.

2. Register COVID-19-positive patients on the NHS Blood and Transplant and the Renal Registry.

3. See guidance on dialysis service delivery.

4. Suspend patients with known/suspected COVID-19 from the waiting list and test for SARS-CoV-2.

5. If SARS-CoV-2 test is negative, assess likelihood of COVID‑19 before returning patients to waiting list.

6. If test is positive, assess whether patients are well enough to return to the waiting list when they:

• have recovered from COVID-19;
• had ≥28 days symptom free; and
• have tested negative.

7. Advise self-isolation for 14 days before transplant.

Transplantation

1. Review induction and immunosuppression regimens.

2. Admit patients earlier to facilitate COVID-19 assessment and minimise cold ischaemia time.

3. Do not routinely request COVID-19 chest computed tomography for asymptomatic patients.

4. Do not start transplant or immunosuppression until patient tests negative for SARS-CoV-2 or in patients likely to have COVID-19 despite negative test.

Patients with known/suspected COVID-19

1. Follow guidance on infection prevention and control.

2. If patients without previously known/suspected COVID-19 show symptoms at presentation, follow guidance on clinical management of possible cases.

3. If COVID-19 is diagnosed in patients not isolated from presentation, follow guidance on management of exposed staff and patients in hospital settings.

Healthcare workers

1. Consider testing front-line staff if appropriate.

2. Staff with known/suspected COVID-19 or who live with someone with known/suspected COVID-19 should self-isolate, be tested as per local protocols and only return to work in accordance with guidance.