5 Care at the time of the transplant

5 Care at the time of the transplant

5.1 Transplant centres should review induction and immunosuppression regimens, taking into account the overall immunosuppression burden for patients in the context of COVID‑19.

5.2 If possible, admit patients receiving a deceased donor kidney earlier than usual, to allow time for COVID‑19 assessment before transplant and to minimise cold ischaemia time. [amended 19 August 2020]

5.3 Assess patients for COVID‑19 on admission for their transplant (and the day before for patients who have been scheduled for a living donor transplant):

  • check their history of social distancing and any possible contact with people who might have COVID‑19

  • conduct rapid turnaround nasopharyngeal swab testing for SARS‑CoV‑2 if a test has not been done in the 3 days before admission or if the results are not available (see recommendation 4.7)

  • conduct a respiratory assessment. [amended 19 August 2020]

5.4 Do not routinely request chest CT scans to screen for COVID‑19 in patients with no symptoms.

5.5 The transplant or immunosuppression should not start until the patient has a negative nasopharyngeal swab test result for SARS‑CoV‑2. NHS Blood and Transplant Kidney Advisory Group has given guidance on swab testing in its guidance for re-opening or expansion of kidney transplant programmes and COVID-19.

5.6 Be aware that a negative result does not definitely rule out infection and must be interpreted in the context of other assessments. Do not start the transplant or immunosuppression if the patient is likely to have COVID‑19 despite a negative test result.

5.7 If patients need dialysis after transplantation, do this in a COVID-19-secure area.

5.8 See sections 5 and 6 of NICE's COVID-19 rapid guideline on arranging planned care in hospitals and diagnostic services for recommendations on providing care for transplant recipients and donors during their hospital stay and after leaving hospital. [19 August 2020]