The impact of COVID-19 pandemic on living donor liver and renal transplantations in Japan: A nationwide survey

Purpose: COVID-19 brought a huge impact on the field of organ transplantation. On 6th March, the Japan Society for Transplantation (JST) COVID-19 task force published an initial statement recommending the temporal suspension of non-lifethreatening living donor transplant program. Until the revised statement documenting a stepwise reopening of transplant activity was released on 29th May, many transplant centers suspended the living donor transplant program accordingly. We aimed to investigate the actual impact of COVID-19 pandemic on living donor liver and renal transplant programs and the efficacy of safety measures to sustain transplant activities. Methods: On behalf of the JST, we performed an internet-based survey toward living donor liver and renal transplant centers nationwide in the study period (January ~ September). The survey was disseminated via e-mail to 165 living donor transplant programs including 32 livers and 133 kidneys. Centers performing both liver and renal transplants were requested to reply respective organs. This survey was funded by the Japanese government (Health and Labor Sciences Special Research Grants). Results: The replies were collected from a total of 155 programs including 31 livers (97% response) and 124 kidneys (93% response). Ninety-three percent of centers followed the statement of JST. A total of 1262 living donor transplantations (229 livers, 1033 kidneys) were performed in the study period. The monthly numbers of liver transplantations did not drop, while kidney dropped 55% from the average during March through June. Preoperative safety measures were taken as follows (% indicates “yes”): SARS-CoV2 screening recipients “89%”/donors “88%”, Chest CT recipients “69%”/donors “58%”, and Self-quarantine (7-28 days) recipients “75%”/donors “65%”. Ninety-five centers performed RT-PCR test for screening and samples were taken through nasopharyngeal, saliva, and nasal in 59%, 30%, and 23%, respectively. Mortality and morbidity of the waitlist patients were reported in 6.5% centers. Postoperative adverse events related to pandemic were occurred in 2.6% centers. Thirty-nine percent of outpatient visits were postponed, and 25% of centers set up tele-medicine accordingly. Conclusions: Most of the living donor renal transplant programs were forced to experience temporal suspension while liver was not. A certain number of waitlist and postoperative patients were affected by COVID-19 pandemic. Standardized safety measures are required to keep the living donor transplant activities in this COVID-19 era.