Faced with the second wave, the concern of patients waiting for a kidney transplant

“It is not normal for Covid-19 to have priority when there are more serious diseases that we leave aside,” annoys Morgane, 26.

The young woman, who lives in Lyon, suffers from an autoimmune disease and after a transplant in 2015, then a rejection, she has been expecting a kidney from 2018. She is afraid of having to patiently endure her illness.

“Imagine this kidney ends up in the garbage”

Because behind the theoretical terms of overloaded resuscitation and deprogramming of non-urgent operations there is a very painful reality. For some patients, especially the 16,000 people waiting for a kidney transplant, the second wave rhymes with the anguish of seeing the possibility of finding a life without dialysis vanish. “During this second wave, hospitals want to stop the kidney transplant business,” says Morgane. It bothers me and I’m not the only one! Imagine that this kidney ends up in the trash and has to wait two, three years before being transplanted, no, I’m not taking it well … We don’t already have much luck for a transplant, while things are changing our lives! “

These patients have difficulty working or having an optimal quality of life when they have to go to a dialysis center three times a week. Another advantage of transplantation: “it increases life expectancy, because a kidney patient has an increased cardiovascular risk in dialysis, while the transplant corrects it”, explains Alexandre Hertig, nephrologist at La Pitié Salpêtrière hospital. . And we know that cardiovascular problems are among the factors of vulnerability to the coronavirus …

The problem is that a patient can wait years for a donor, living or deceased, to be compatible with him. In Ile-de-France the average time to get a kidney transplant varies between three and four years… “It’s not like a stock of masks or peanuts, ironically the doctor. If you are called for a transplant it is because at a T moment, a donor is very close to you in terms of blood groups and antigens. You could lose the kidney of your life if you fail. If the transplant is interrupted for two weeks, I cannot tell my patients “don’t worry, in three months you will be transplanted” ”.

Do better than in the first wave

This situation, which heavily penalizes these patients, did not have to recur. In the first wave, no kidney transplants were performed between March 18 and May 11. “In March, we did not know what Covid-19 would give to an immunocompromised patient,” specifies Alexandre Hertig. However, we must necessarily put a patient in this state of vulnerability for the transplant to have a chance to undertake. “Unlike heart, lung and liver transplants, which are vital because there is no lasting artificial system, patients with kidney failure can survive on dialysis,” continues the doctor. This is why only the kidney transplant was stopped. “

Which was not without consequences. “We left the kidneys in place of 110 deceased donors, so 220 kidneys were lost, regrets Magali Leo, head of the defense department of Renaloo, an association of patients with kidney failure. At the time, the organization did not contest this decision. But very quickly, we came together to say “never again!”. And that if a second wave arose, we had to organize ourselves so that the kidney transplant could continue. “

Especially since we discovered in retrospect that, contrary to what one might imagine, the number of dialysis patients infected by the coronavirus was double that of former transplant recipients … Another important information: “there is no very negative signal from our colleagues who continued to transplant hearts and lungs, indicating that it was sheer folly to transplant people during the pandemic, ”adds Alexandre Hertig.

How to keep this business?

Maintaining this activity is a priority shared by the Ministry of Health. Indeed, Olivier Véran made it clear that transplants, just like cancer cures, were to continue during this second wave, despite the activation of the white plans. Same story from the Biomedicine Agency, responsible for transplants. It issued recommendations on 22 September. As a first step, hospitals must maintain a Covid patient-free network within hospitals. And in case this is no longer sustainable, he recommends that they can be transferred to other institutions. It is clear that hospitals organize and consider cooperation so that these kidneys are not lost. “We expected this cooperation to take place,” continues Magali Leo. However, as far as we know, except in Ile-de-France, this is not the case. “

In its latest press release of 9 November, the French Agency for Biomedicine assured that “in recent weeks, thanks to the mobilization of all, the samples and transplants of deceased donors have continued at a very satisfactory level. In October 2020, 266 kidney transplants were thus carried out, compared to 283 in October 2019: despite the difficult health context, the observed decrease is only 6% “.

But this was before the reconfirmation announced on October 30 … And the Agency did not rule out that the situation could become tense: “in the coming weeks, given the dynamics of the epidemic, the waiting times for access to the transplant kidney might be stretched in particular due to the unavailability of medical and paramedical teams, as well as operating theaters. “

Contradictory feedback

Is that so? In any case, patients are worried about the lack of transparency… “In Pitié we have a transplant every two or three days, which is our normal rhythm, reassures Alexandre Hertig. But we see a tendency to decrease activity, according to my information, of the order of 10% in France and 20% in Ile-de-France. It is related to the fact that when resuscitations are saturated, they cannot host an organ donor. This is why sheaf saturation also affects patients waiting for an organ, be it a kidney, heart or liver. “

If tomorrow more intensive care units were in overdrive, just as many patients would be penalized. “During the follow-up committees with the Biomedicine Agency, we are told that everything is fine, but we have feedback from the field confirming that the appointments have been canceled, warns Magali Leo. There was a change of strategy in the commitments. What we lack is the assurance that all means are put in place to maintain this business. “