Readiness for the Next Pandemic: A Nurse Practitioner-Driven COVID-19 Management Model for Kidney Transplant Recipients.

Abstract

Background: With the rise of virulent pathogens, the transplant community faces unprecedented challenges in caring for immunocompromised patients. Effective diagnosis, treatment, and follow-up are essential, with prompt immunosuppression adjustment and hospitalization for decompensated patients being critical for survival.

Objective: Our study aimed to determine if a nurse practitioner-driven care model improves outcomes for kidney transplant recipients who contracted COVID-19.

Methods: We conducted a retrospective study of kidney transplant patients who contracted COVID-19 (N = 101) from April 1, 2020 to April 30, 2021. Patients were classified into 2 groups: those presenting to the emergency department with COVID-19 symptoms and those diagnosed with COVID-19 and followed by nurse practitioners. Nurse practitioners monitored this second group daily via telephone and/or video call. They provided symptom assessment, immunosuppression adjustment, health counseling, and emotional support.

Results: Patients who were identified as decompensating had admissions arranged to the nearest hospital or our transplant center. In the intervention group (n = 66), immunosuppression was adjusted more rapidly (4.5 days vs 7 days), leading to shorter illness duration (17 days vs 26 days), fewer acute kidney injuries (50.0% vs 68.6%), lower readmission rates (5.0% vs 20%), and better survival (97.0% vs 77.1%).

Conclusion: As we have more preventive and treatment options for COVID-19, prompt interventions and close monitoring as demonstrated in our model may be key to achieving health outcomes including graft and patient survival. Our strategies can be applicable in instances of future outbreaks of virulent pathogens and help protect and save lives within our kidney transplant patient population.