Pancreas and islet transplantation in the UK during the COVID-19 era
Claire Counter1, Sanjay Sinha2, Anand Muthusamy3, Martin Drage4, Chris Callaghan4,12, Doruk Elker5, Simon Harper6, Andrew Sutherland7, David Van Dellen8, Paul Johnson9, Derek Manas10,12, James Shaw11, Colin Wilson10, John Forsythe7,12, Stephen Hughes9, John Casey7, Steven White10.
1Statistics and Clinical Research, NHS Blood and Transplant, Bristol, United Kingdom; 2Department of Surgery, Oxford University Hospitals NHS Trust, Oxford, United Kingdom; 3Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; 4Department of Nephrology and Transplantation, Guy’s and St Thomas’s NHS Foundation Trust, London, United Kingdom; 5Cardiff Transplant Unit, University Hospital of Wales, Cardiff, United Kingdom; 6Department of HPB and Transplant Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom; 7Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; 8Manchester Renal Transplant Unit, Manchester Royal Infirmary, Manchester, United Kingdom; 9Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom; 10Department of HPB Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom; 11Institute of Cellular Medicine, Newcastle University , Newcastle upon Tyne, United Kingdom; 12Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, United Kingdom
NHS Blood and Transplant Pancreas Advisory Group.
Introduction: The World Health Organization declared a pandemic of coronavirus disease SARS-CoV-2 (COVID-19) on 11 March 2020. In this analysis, the impact of COVID-19 on beta cell replacement therapy in the UK was reviewed.
Method: At the start of the pandemic all whole pancreas transplant programs in the UK closed due to the lack of ITU/HDU bed availability and staff redeployment. Islet centres remained open for priority patients and isolation laboratory services were maintained throughout. A National Pancreas/Islet Transplant COVID-19 taskforce was convened and met on a twice monthly basis throughout the pandemic. This mirrored other organ specific UK transplant advisory groups, with the express aim of facilitating clinical governance and enabling the reopening of units over time. Pancreas and islet donation and transplant activity in the period 11 March 2020 to 10 March 2021 was compared with the same period the previous year.
Results: Of the 2180 patients with a functioning (insulin independence for pancreas or C-peptide ≥50pmol/l for islet) graft at the beginning of the pandemic or those subsequently transplanted, 126 (5.8%) tested positive for COVID-19 and two died (1%). In the 2020-2021 period there were 1615 solid organ donors compared with 2840 in the previous year (down 43%). Of the 625 solid organ donors with a pancreas offered, 32% had the pancreas retrieved compared with 51% of 918 in the previous period.
During a six-week period between 1 May and 12 June 2020 no pancreas or islet transplants were performed, although solid organ donation continued at a much lower rate. There were 97 whole pancreas and islet transplants performed in the UK compared with 212 in the same period the previous year (down 54%). Of the 97 transplants, 81 (84%) were simultaneous pancreas and kidney (SPK), with the remainder being solitary pancreas (3%), simultaneous islet and kidney (SIK) (5%) and islet transplant alone (ITA) (8%).
Of the 84 pancreas transplant recipients, as of 12 May 2021, four patients had tested positive for COVID-19 but none have died. Of the 84 transplants, two grafts failed within the first week from vascular thrombosis but neither of the patients had tested positive for COVID-19. The rate of failure within the first month post-transplant is equivalent to that seen in the previous time period.
Of the 13 SIK and islet alone transplant recipients, two patients tested positive for COVID-19 but neither have died. Of the 13 transplants, one is known to have failed within a month and this is equivalent to that seen in the previous time period.
Discussion: In the UK, pancreas and islet transplantation have continued during the pandemic, albeit at a much lower rate. Some centres took longer to restart pancreas transplantation due to higher rates of COVID-19 infections in their region or other COVID-related impacts on service. Outcomes following transplantation within the COVID era are, so far, similar to that seen in the period prior to the pandemic.