First pediatric transplant to a patient who has passed Covid-19

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The Vall d'Hebron University Hospital in Barcelona has performed the first transplant in Spain to a pediatric patient who has passed Covid-19. This is a teenager who suffered from mitral stenosis, congenital heart disease, and who received a transplant of this organ.

"She is a complex patient who has already undergone four major heart surgeries throughout her life due to her heart disease," explains Ferran Gran, pediatric cardiologist and medical coordinator of Pediatric Heart Transplantation in Vall d'Hebron. "With several complications, including severe pulmonary hypertension, it was decided that the best medical option was to have a heart transplant," he adds.

During the preoperative consultation in which the consent documents had to be signed to do the heart transplant, it was detected that the patient suffered from Covid-19 through a screening test.

Medical team that performed the operation

Despite the fact that PCR has always been carried out among the battery of pre-transplant tests routinely since the coronavirus pandemic began, in this case the Vall d'Hebron medical team previously detected symptoms compatible with pneumonia. The PCR was positive and the patient was admitted to the Children's Hospital for pneumonia caused by the coronavirus.

Once recovered, she was discharged. "The patient did not have a serious picture from Covid-19. Her clinical evolution was quite good," explains Pere Soler, head of the Pediatric Infectious Pathology and Immunodeficiency Unit.

Already at home, in one of the calls from the telephone follow-up program that Vall d'Hebron makes with the patients discharged by Covid-19, the mother told the medical team that the girl was not feeling well and that she believed it was because of his heart problem.

"We contacted Pediatric Cardiology and the patient came to our center where, five hours after arriving, she suffered cardiac arrest due to an arrhythmia , which is why she was admitted to the Pediatric ICU," adds Soler.

Therefore, the patient was admitted to the Vall d'Hebron Pediatric ICU for heart failure caused by her heart disease.

The heart transplant could be carried out two weeks later. "The intervention was performed one month after the minor suffered from pneumonia due to Covid-19, exceeding the recommended 21-day safety period after the complete resolution of all the clinical manifestations of the disease," says Joan Balcells. , head of the Pediatric ICU of Vall d'Hebron.

"In addition, two PCR tests were performed, separated by a period of 48 hours and that came out negative, to ensure that his recovery was total, " added Balcells.

The Covid-19 pandemic has modified some aspects of the transplant process, as stated by Raúl Abella, head of the Vall d'Hebron Pediatric Cardiac Surgery Service.

"Before Covid-19, we used to go to the donor hospital to do the organ removal and collection. Now, for safety, the professionals from the donor hospital are in charge."

In the case of donors, those who have suffered any clinical pathology compatible with Covid-19 are discarded. According to the medical protocol, an epidemiological survey is carried out to find out if the donor or someone in his family has suffered from Covid-19 21 days before the donation and, although the donor has not presented any clinical picture of the disease, it is performed a PCR test 24 hours before extraction.

"The fact that the patient had suffered Covid-19 made us fear that the virus could have aggravated the pulmonary hypertension that she already had or produced some residual injury that made transplantation impossible, but fortunately this was not the case," explains Abella.

Vall d'Hebron has performed a total of 13 transplants since March 13, when the state of alarm for the COVID-19 pandemic was declared: two childhood liver transplants and two to adult patients, two infant kidney transplants and five to patients adults, a lung transplant to an adult and a heart transplant to a pediatric patient. In the whole of Catalonia, between March 13 and May 13, a total of 23 transplants were performed. In Spain, 206 transplants have been done.

"The Vall d'Hebron pediatric transplant program has shown strength and resilience in a situation as adverse as the coronavirus pandemic and has made possible success stories like this," said Teresa Pont, medical coordinator for transplants in Vall d'Hebron. .

According to the recommendations of the National Transplant Organization (ONT) and the Catalan Transplant Organization (OCATT), during the worst moments of the COVID-19 pandemic, transplant activity has been restricted to patients in emergency situations and who present greater clinical severity, as well as patients with more difficulties in receiving a transplant, such as minors, due to the difficulty of finding organs.

In accordance with the criteria of The Trust Project

• Science and health
• Coronavirus
• Covid 19

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