Trasplante renal en época COVID-19 en España

espanolINTRODUCCION: La epidemia de COVID-19 plantea importantes retos en el ambito de la donacion y el trasplante renal. El objetivo de este articulo es establecer unas recomendaciones generales dirigidas a los equipos quirurgicos de trasplante renal durante la era COVID-19. MATERIAL Y METODOS: El documento se basa en la evidencia cientifica disponible sobre la infeccion causada por SARS-CoV-2 y la experiencia de los autores en la pandemia COVID-19. Se realizo una busqueda web y en PubMed utilizando las palabras clave “SARSCoV-2”, “COVID-19”, “COVID Urology”, “COVID-19 surgery” y “kidney transplantation”. Se ha utilizado una tecnica de grupo nominal modificada. RESULTADOS: En momentos de saturacion del sistema sanitario, se deberan diferir los trasplantes renales, salvo en pacientes con bajas posibilidades de trasplante y un rinon optimo disponible, trasplantes combinados o pacientes en situacion de urgencia vital. Se debera hacer cribado del virus SARS-CoV-2 en todos aquellos donantes y receptores que tengan sospecha clinica, hayan estado en zonas de alto riesgo o hayan compartido proximidad con casos confirmados de COVID-19. Nos e procedera con la donacion ni con el trasplante en casos confirmados de COVID-19. Las cirugias deberans er eficientes, cortas y centradas en las que menor estancia hospitalaria conlleven. En casos de urgencia, se extremaran las medidas de proteccion con equipos de proteccion individual. El personal quirurgico sera el menor posible y se minimizaran las estancias en quirofano. Las consultas urologicas de trasplante sin riesgo seran realizadas telematicamente cuando sea posible. CONCLUSION: La cirugia de trasplante renal debe ser eficiente en cuanto a recursos sanitarios, humano sy beneficio clinico. Se debe garantizar la seguridad de los potenciales donantes y receptores, adoptando medidas de proteccion individual y realizando cribado para SARS-CoV-2. EnglishINTRODUCTION: The COVID-19 pandemic poses significant challenges in the area of kidney donation and transplantation. The objective of this article is to establish genral recommendations for surgical teams to manage the kidney transplant program during the COVID-19 era. MATERIAL AND METHODS: This document is based on the scientific evidence available on the infection caused by SARS-CoV-2 and the experience of authors during the COVID-19 pandemic. A web and Pubmed search was performed using the keywords “SARS-CoV-2”, “COVID-19”, “COVID Urology”, “COVID-19 surgery”, and “kidney transplantation.” A modified nominal group technique was used. RESULTS: When health system saturation occurs, kidney transplants should be deferred, except in patients with low transplant possibilities and an optimal kidney available, combined transplants or life-threatening situations. Screening for the SARS-CoV-2 virus should be done in all those donors and recipients with clinical symptoms consistent with COVID-19, who have visited or live in high-risk areas, or who have been in close contact with confirmed cases of COVID-19. Donation and transplantation will not proceed in confirmed cases of COVID-19. Surgeries should be based on general recommendations in the COVID-19 era and will be efficient, short, and focused on those with the shortest hospital stay. In emergencies, protective measures will be taken with personal protection equipment. Surgical staff will be only the strictly necessary, and permanence in the OR should be minimized. Transplant urology consultations will be conducted by teleconsultation when possible. CONCLUSION: The safety of potential donors and recipients must be guaranteed, adopting individual protection measures and screening for SARS-CoV-2. Kidney transplant surgery must be efficient in terms of health, human resources, and clinical benefit. All non-urgent transplant activities should be delayed until the improvement of the local condition of each center.