Impact of COVID-19 on living donor liver and kidney transplantation programs in Japan in 2020

Abstract

Background: Although many transplant programs have been forced to suspend living donor transplants due to the emergence of coronavirus disease (COVID-19), there are relatively few real-time databases to assess center-level transplant activities. We aimed to delineate the actual impact of COVID-19 on living donor transplant programs and the resumption process in Japan.

Methods: In a nationwide survey, questionnaires were sent to 32 liver transplant programs that had performed at least more than one case of living donor liver transplantation in 2019 and 132 kidney transplant programs that had performed more than one living donor kidney transplantation in 2018.

Results: Thirty-one (96.9%) and 125 (94.7%) liver and kidney transplant programs responded, respectively. In the early pandemic period, 67.7% (21/31) of liver programs and 29.8% (37/125) of kidney programs were able to maintain transplant activities similar to those during the pre-pandemic period. After temporal suspension, 58.1% of kidney programs resumed their transplant activity after the number of local COVID-19 cases peaked. Establishing institutional COVID-19 screening, triage, and therapeutic management protocols was mandatory to resume transplant activity for 64.5% and 67.7% of liver and kidney programs, respectively. In the future wave of COVID-19, 67.7% of liver programs would be affected by institutional COVID-19 intensive care unit-bound patient numbers, and 55.7% of kidney programs would stop if hospital-acquired severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection spreads.

Conclusions: THIS NATIONWIDE SURVEY REVEALED FOR THE FIRST TIME HOW LIVING DONOR LIVER AND KIDNEY: transplant programs changed in response to the COVID-19 pandemic in a country where living donor transplantations are predominant.

Keywords: COVID-19; living donor kidney transplantation; living donor liver transplantation.

FIGURE 1

(A) The 13 prefectures where the state of emergency was declared in Japan on April 7 and 16, 2020 to prevent the spread of coronavirus disease (COVID‐19) (Saitama, Chiba, Tokyo, Kanagawa, Osaka, Hyogo, Fukuoka, Hokkaido, Ibaraki, Ishikawa, Gifu, Aichi, and Kyoto). (B) Red zone: transplant programs located in the 13 prefectures where the state of emergency was issued. Blue zone: the remaining 34 prefectures where the state of emergency was not issued. (C) The monthly case numbers of liver and kidney transplantations in 2020 along with the timing of when the state of emergency was declared; the first and fourth versions of the guidelines were published by the Japan Society for Transplantation (JST). In version 1, the JST recommended continuing transplants for life‐saving organs such as the heart, lungs, and status 1 livers, requiring a risk–benefit assessment for each case. The JST recommended postponing any nonurgent transplants of the kidney, pancreas, and bowel, as well as all nonlife‐threatening living donor transplantations. In version 4, the JST recommended resuming living donor transplant programs based on the local community and institutional transmission risk. They also proposed a checklist to help determine the restart of the living donor kidney transplantation (LDKT) programs. The JST guidelines are summarized in Table S2. (D)–(G) The monthly case numbers of liver and kidney transplantations in 2020 categorized by blue and red zone groups. The straight line indicates the average transplantation case number during the respective period. (D) Living donor liver transplantation (LDLT); (E) deceased donor liver transplantation (DDLT); (F) LDKT; (G) deceased donor kidney transplantation (DDKT). Blue zones indicate prefectures where emergency measures were not implemented; red zones indicate prefectures where emergency measures were implemented