No abstract

COVID-19 spreads rapidly throughout the Philippines. The first verified case of COVID-19 in the Philippines was detected on January 30 after SARS-CoV-2 viral RNA was recovered from the initial swabs using a polymerase chain reaction. This study aimed to determine the impact of COVID-19 on the number of kidney transplantation (KT) performed at the National Kidney and Transplant Institute (NKTI) in the Philippines. Using the Organ Transplant Unit of the NKTI, the study compared the data of living donor kidney transplantation (LDKT) and deceased donor kidney transplantation (DDKT) from March to December 2019 to 2020. In March and April 2020, the NKTI suspended the KT program when the World Health Organization declared the COVID-19 pandemic, including the pretransplantation orientation. There were 300 KT conducted in 2019, compared to 129 KT in 2020, a decline of 43%. A monthly average of 7 LDKT in 2020, compared to 25 in 2019. There were 65 LDKTs were performed during the pandemic compared to 283 in 2019. Following the announcement of the COVID-19 pandemic, there was no DDKT. In 2020, the majority of patients who received tacrolimus as their initial calcineurin inhibitor were between 31 and 40 years old, male, with chronic glomerulonephritis as their primary kidney illness, blood type O+, and 3 human leukocyte antigen mismatches. Open donor nephrectomy was 42 (35%) versus 90 (32%). There was one retransplant (0.8%) in 2019, compared to 16 (5%). In 2020, nine patients (3%) died within a year after KT, but in 2021, only two (1.6% of patients) died. This study showed that the number of KT at the NKTI decreased throughout the first year of the COVID-19 pandemic and could resume safely while observing safety protocols. Due to the higher risk posed by dialysis patients, renal transplantation should be maintained. This could be accomplished through a phased approach based on risk tolerance and hospital capacity.

Purpose: This study aimed to assess changes in renal function during the acute disease and up to three months after the onset of symptoms among kidney transplant patients surviving COVID-19. Methods: This ongoing single-center observational prospective study included kidney transplant recipients diagnosed between March 2020 and May 2021 and survived the first 28 days. Before diagnosis, baseline renal function was defined as the mean of the last three creatinines. The follow-up period was three months. We used a one-way ANOVA test to compare the mean eGFR in baseline, 28 days, and three months after COVID-19. The CKD-EPI equation was used to estimate GFR. Results: Among the 787 patients, the mean age was 48.5 years, 59.3% were male, and 68.0% were white. Comorbidities such as hypertension, diabetes, and cardiopathy were present in 70.4%, 25.3%, and 3.9%, respectively. The mean body mass index was 26.9 kg/m², and baseline GFR was 51,9 ± 20.1 ml/min/1.73m². Immunosuppression was reduced by 27.1% and suspended in 9.5% of cases. In 30.3% of the patients, acute kidney injury occurred, 7.8% needed dialysis support, and 2.5% had graft loss. There was a decline in renal function at 28 days (50.0 ± 22.1 ml/min/1.73m²; p<0.001) and 3 months (47.3 ± 21.0 ml/min/1.73m²; p<0.001) after COVID-19. Among the patients, 47.3% did not return to baseline eGFR values within three months, and 19.9% reduced renal function at least 25%. Conclusions: COVID-19 does impact early renal function decline in KTR. These data reassure that KTR represents a group that benefits from early access to effective preventive strategies.