Kidney transplantation and the lockdown effect

The coronavirus disease 2019 (COVID-19) disrupted the healthcare system: when ‘business as usual’ is no longer possible, as intensive care units (ICUs) follow the principle of ‘capacity to benefit’ to accommodate as many COVID-19 patients requiring ventilation as possible, there is an important decrease in the organ pool [1]. The lack of ICU capacity to accommodate donors dying from different reasons than COVID-19 leads to a drastic reduction of the transplant activity, important resource to be preserved in a safe and clean environment, separated by the rest of the dedicated COVID-19 beds. There is evidence, in fact, that COVID-19 could be a nosocomial infection [2]. Furthermore, transplantation requires immunosuppression. In population at risk, the innate immune system fails to produce an adequate adaptive response, so persistent self-induced inflammation can cause mortality and mounting an early adaptive immune response may save lives [3], a concept that fails to match with the required post-transplant immunosuppression.