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Balancing immunity level for post transplant patients is crucial

Transplant patient at all times walk a tight rope, being severely immune suppressed by transplant medicines being taken religiously to prevent rejection of their "non-self" transplanted organ. This makes them vulnerable to all ubiquitous infections how so ever trivial for normal people. Now Covid-19 enters their life.

Some outcomes of Covid-19 pandemic in previously transplanted patients are as below:

Transplant patients may not show classical symptoms of covid infection. They may not get fever. Even their lab tests are at variance compared to normal people, such as less lymphopenia and lower IL6 levels. This variation in clinical presentation confounds the picture significantly and further delays their early diagnosis and prompt effective management.

Some ominous signs are- rapid onset of breathlessness, very high d-dimer troponin and CRP behove a guarded prognosis. In major reports from China a mortality rate of about 25 to 30% has been reported in transplanted patients.

Transplant patients should keep a buffer stock of their transplant medicines along with antidiabetic, antihypertensive and all other essential medicines they are on. Any noncompliance in taking their medicines can have far reaching consequences such as graft rejection and other disastrous sequel.

Reduce visits to hospital and manage by telemedicine as far as possible. However, in covid times they have to discuss with their nephrologist when, how and where they should get their tests done. There should be zero noncompliance. This is because early rejection/damage of their transplanted kidney/organ is asymptomatic and can be picked up only by lab tests like serum creatinine etc.

Unfortunately if the patient becomes sick they will need hospitalization, oxygen, BIPAP or ventilatory support.These patients have to reduce their immunosuppression to enable their immune system to recuperate and fight the covid virus. Initially anti metabolites like mycophenolate or azathioprine are tapered.If patient becomes critically sick then all immunosuppressive medicines are stopped with the exception of steroids.

Besides fluids, nutrition, life support, the patient may need potent antibiotics, anti viral medicines like chloroquin/HCQS, Remdesivitr, Ritonavir to name a few.

Once the patient starts recovering, their transplant medicines are gradually reintroduced. Transplant patients have faced a very high mortality. In an Italian study by Alberci 25% transplant patients succumbed to their illness.

The Covid vaccine appears to be at least a year away. The gullible patients must not fall prey to con men proclaiming cure and rapid recovery from corona infection. Any such Unscientific medicine may bring more grief to the patient.

They should watch their weight; eat freshly cooked food, more of fruits and vegetables. Avoid overnight refrigerated foods if possible, especially in summer months. This is to reduce their chances of getting diarrhoea.

Avoid depression and negativethoughts by doing regular indoor exercises, yoga and meditation etc. Remember "even this shall pass".

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