Insights and pearls of healthcare systems management of COVID-19 in Asia and its relevance to Asian transplant services

Terence Kee 대한이식학회 2021 Korean Journal of Transplantation Vol.35 No.3

Asia is now the new epicenter of the coronavirus disease 2019 (COVID-19) pandemic, yet mortality rates remain among the lowest in the world. This review paper summarizes key findings from the literature in Asia on how healthcare systems, including transplant programs, have developed innovative solutions and countermeasures to mitigate the adverse impact of the COVID-19 pandemic. A review of literature using PubMed was performed, where only publications addressing COVID-19 and healthcare systems from Asia were selected. Whenever possible, the impact of COVID-19 and the countermeasure responses from transplant healthcare systems were highlighted in these publications. Transplantation in Asia has been affected to varying degrees, although many Asian countries have continued transplantation while adopting defenses that have resulted in a low COVID-19 incidence rate among transplant recipients. These defenses include protected pathways for patients, surveillance through protocol screening for COVID-19, team and infrastructure segregation, adoption of telemedicine, and patient outreach and education. Transplant healthcare systems in Asia have been effective at varying levels of success during the COVID-19 pandemic. As the pandemic continues, transplant health- care systems must develop operational frameworks to sustain transplant activity in the new normal.

Clinical characteristics, outcomes, and management of COVID-19 in kidney transplant recipients across Asia: an ASTREGO report

Terence Kee,Jong Cheol Jeong,Harun Ur Rashid,Nura Afza Salma Begum,Mel-Hatra Arakama,Romina Danguilan,Lkhaahuu Od-Erdene,Rosnawati Yahya,김예림,Hersharan Kaur Sran,Becky Ma,Maggie Ma,Devinder Singh Rana 대한이식학회 2021 Korean Journal of Transplantation Vol.35 No.4

Background: Asia is the global epicenter of the coronavirus disease 2019 (COVID-19) pandemic; however, COVID-19–related mortality in Asia remains lower than in other parts of the world. It is uncertain whether the mortality of COVID-19-infected kidney transplant recipients (KTXs) from Asia follows the lower mortality trends of the younger Asian population. Methods: Specific transplant centers from countries in the Asian Society of Transplantation were invited to participate in a study to examine the epidemiology, clinical features, natural history, and outcomes of COVID-19 infections in KTXs. Data were analyzed and compared with those of large cohort studies from other countries. Results: The study population was 87 KTXs from nine hospitals in seven Asian countries. Within the study population, 9% were aged 60 years and older, and 79% had at least one comorbidity. The majority of patients (69%) presented with mild-to-moderate COVID-19 severity. Disease progression was more frequently encountered among those with moderate or severe infection (23%) and non-survivors (55%). The mortality rate was 23% (n=20) and differed according to the level of care: 12% (n=1/8), 15% (n=10/67), and 100% (n=9/9) of patients managed as outpatients, in the general ward, and in the intensive care unit, respectively. Disease severity at the time of presentation was an independent predictor of mortality. Compared with the mortality rates in other studies worldwide, mortality rates in the current study were comparable. Conclusions: Mortality in Asian KTXs who were infected with COVID-19 remains high and could be related to comorbidity burden and the constraints of the general healthcare system when the COVID-19 caseload is high.

Transplantation in Asia during the coronavirus disease-19 (COVID-19) pandemic: briefs from member countries of the Asian Society of Transplantation

Terence Kee,정종철,하종원,Harun Ur Rashid,Nura Afza Salma Begum,Maggie K.M. Ma,Vivek Kute,Kenji Yuzawa,Rosnawati Yahya,Ghazali Ahmad,Lkhaakhuu Od-Erdene,Dibya Singh Shah,Romina A Danguilan,Curie Ahn,Devinde 대한이식학회 2020 Korean Journal of Transplantation Vol.34 No.2

The coronavirus disease-19 (COVID-19) pandemic has affected 1,029,968 people in Asia as of May 16, 2020. Although Asia was the first continent to be affected, many countries in the region continue to battle COVID-19, which challenges the way transplant programs provide their services. Given the diversity of healthcare systems in Asia, the countermeasures in response to COVID-19 are as potentially diverse. This review reports the experiences of transplant services in member countries of the Asian Society of Transplantation (AST) as well as provides a platform for sharing of best practices during the COVID-19 pandemic. AST invited member countries to provide a short description of their transplant experiences during the COVID-19 pandemic. Whenever information is available, countries were asked to provide information on COVID-19 related statistics, status of transplant programs, mitigation measures taken to prevent COVID-19, and other areas of transplant programs impacted by COVID-19. Ten countries responded to the invitation of which seven still have active transplant programs at varying levels of activity. All countries have protocols for donor/recipient screening and countermeasures to prevent COVID-19 infections in recipients and healthcare providers. Interestingly, these countries report only 16 transplant recipients with COVID-19 infection but no cases of donor-transmitted COVID-19 infection. Despite the diversity of healthcare systems in Asia, transplant centers in Asia have taken appropriate precautions to avoid COVID-19 infections, though the long-term impact of COVID-19 remains unclear.

Bariatric Surgery in Kidney Transplant Candidates and Recipients: Experience at an Asian Center

Sarah Ying Tse Tan,Phong Ching Lee,Sonali Ganguly,Peng Chin Kek,Terence Kee,Quan Yao Ho,Sobhana Thangaraju 대한비만학회 2022 Journal of obesity & metabolic syndrome Vol.31 No.4

Background: Kidney transplant (KT) candidates and recipients with obesity experience more frequent complications such as infection, poorer allograft outcomes, diabetes, and mortality, limiting their eligibility for transplantation. Bariatric surgery (BS) is not commonly performed among KT patients given concerns about immunosuppression absorption, wound healing, infections, and graft outcomes. Its role has not been described before in an Asian KT patient setting. Methods: A retrospective review of patients who underwent BS at the largest KT center in Singapore from 2008 to 2020 was conducted. Metabolic outcomes, immunosuppression doses, graft outcomes, and mortality were studied. Results: Seven patients underwent BS and KT (4 underwent BS before KT, 3 underwent BS after KT; 4 underwent sleeve gastrectomy, 3 underwent gastric bypass). Mean total weight losses of 23.8% at 1 year and 18.6% at 5 years post-BS were achieved. Among the five patients with diabetes, glycemic control improved after BS. There were no deaths in the first 90 days or graft loss in the first year after KT and BS. Patients who underwent BS after KT had no significant changes in immunosuppression dose. Conclusion: BS can be safely performed in KT recipients and candidates and results in sustainable weight losses and improvements in metabolic comorbidities. Although no major complications were observed in our study, close monitoring of this complex group of patients is imperative.

Safely navigating kidney transplantation during the COVID-19 pandemic: the Singapore General Hospital’s experience

Carolyn Shan-Yeu Tien,Ian Tatt Liew,Quan Yao Ho,Sobhana Thangaraju,Maslinna Binte Abdul Rahman,Constance Lee,Nicole Chelsi Xin Hui Leah,Xia He,Li Ting Siew,Terence Yi Shern Kee 대한이식학회 2023 Korean Journal of Transplantation Vol.37 No.2

Background: The coronavirus disease 2019 (COVID-19) pandemic curtailed transplant activities worldwide, driven by concerns about increased COVID-19-related mortality among kidney transplant recipients (KTRs), infections originating from donors, and decreased availability of surgical and intensive care resources as healthcare resources are reallocated for pandemic response. We examined the outcomes of KTRs at our center before and during the COVID-19 pandemic. Methods: We conducted a retrospective single-center cohort study examining the characteristics and outcomes of patients undergoing kidney transplantation during two periods: January 1, 2017 to December 31, 2019 (pre-COVID-19 era) and January 1, 2020 to June 30, 2022 (COVID-19 era). We reviewed perioperative and COVID-19 infection-related outcomes in both groups. Results: A total of 114 transplants were performed during the pre-COVID-19 era, while 74 transplants were conducted during the COVID-19 era. No differences in baseline demographics were observed. Additionally, there were no significant differences in perioperative outcomes, except for a longer cold ischemia time during the COVID-19 era. However, this did not result in an increased incidence of delayed graft function. Among the KTRs infected with COVID-19 during the pandemic era, no severe complications such as pneumonia, acute kidney injury, or death were reported. Conclusions: With the global transition to an endemic phase of COVID-19, it is imperative to revitalize organ transplant activities. Effective containment workflow, good vaccination uptake, and prompt COVID-19 treatment are essential to ensure that transplants can proceed safely.

Cardiac evaluation for end-stage kidney disease patients on the transplant waitlist: a single-center cohort study

Swati Vijayan,Quan Yao Ho,Choong Hou Koh,Ian Tatt Liew,Sobhana Thangaraju,Ningyan Wong,Yann Shan Keh,Zi Hui Sharel Ong,Jia Qin Tan,Khung Keong Yeo,Terrance Siang Jin Chua,Terence Kee 대한이식학회 2022 Korean Journal of Transplantation Vol.36 No.3

Background: Cardiac evaluation before deceased donor kidney transplant (DDKT) remains a matter of debate. Data on Asian countries and countries with prolonged waiting times are lacking. This study aimed to assess the outcomes of patients referred for DDKT after a cardiac evaluation at an Asian tertiary transplant center. Methods: This single-center retrospective review analyzed patients who were referred for waitlist placement and underwent cardiac stress testing between January 2009 and December 2015. Patients with cardiac symptoms were excluded. The primary outcome was three-point major adverse cardiovascular events (MACE), a composite of non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death. Results: Of 468 patients referred for DDKT, 198 who underwent cardiac stress testing (myocardial perfusion studies in 159 patients and stress echocardiography in 39 patients) were analyzed. MACE occurred in 20.7% of the patients over a median follow-up of 4.6 years. Cardiac stress tests were positive for ischemia in 19.7% of the patients. Coronary angiography was performed in 63 patients, including 29 patients with diabetic kidney disease and negative cardiac stress tests. Significant coronary artery disease (CAD) was detected in 27 patients (42.8%), of whom 18 underwent revascularization. MACE was associated with significant CAD on coronary angiography in the multivariable analysis. Cardiac stress test results were not associated with MACE. Amongst diabetic patients who had negative cardiac stress tests, 37.9% had significant CAD on coronary angiography. Conclusions: The cardiovascular disease burden is significant amongst DDKT waitlist candidates. Pretransplant cardiac screening may identify patients with significant CAD at higher risk of MACE.