key: cord-265833-vj5nrip6
authors: Coates, P Toby; Wong, Germaine
title: The Forgotten Fallen: painful reality of a pandemic
date: 2020-06-15
journal: Kidney Int
DOI: 10.1016/j.kint.2020.06.002
sha: 
doc_id: 265833
cord_uid: vj5nrip6

nan

When COVID-19 became a global pandemic, health professionals were particularly concerned of the potential risk it might impose on the most vulnerable groups, including our kidney and kidney pancreas transplant recipients. Emerging data from the US and Europe indicated the risk of early deaths for hospitalised transplant recipients is at least 20% 1 , and these patients experienced more rapid disease progression and lower lymphocyte counts than immunocompetent patients with COVID-19 2 . For those who did not suffer from the direct and devastating impact of the disease, COVID-19 added a layer of complexity including fear, anxiety and apprehension, making it extremely difficult to care for these patients who are immunosuppressive therapy who all presented acute rejection after stopping their medications during the social distancing "stay at home" orders, and the dilemma's faced by these patients are global. When health authorities mandate effective social distancing and isolation as the key strategy in controlling the pandemic, this inevitably reduces patient engagement with the health system. Additional financial stress and high unemployment due to the economic impact of COVID-19 are potentially devastating on families. If the choice is to feed your children and your family or buy your medications, most will put the family first. sensitization in those with rejection thus compounding the difficulty for a subsequent transplant and thereby adding to the dialysis population. Acute rejection and loss of function due to non-adherence in deceased donor grafts is a tragedy for the donor families, who rightly should expect better care of their loved ones' organs. Non-adherence, a complex human behaviour, often considered as a taboo, has always existed before Covid-19. This global pandemic has further exposed this chronic problem, which may be driven by a combination

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