249.7: Re-Initiating Living Donation Kidney Transplantation in Covid-19 Pandemic; Indonesia Experience

Introduction: Kidney transplantation (KT) is one of many health care procedures impacted by the COVID-19 pandemic and most KT centres decided to withhold their program, especially living kidney transplantation. With 45 years of experience, the KT program in Indonesia’s KT centres in Jakarta was also stopped for a month in April 2020 due to uncertain conditions after the first COVID-19 case was detected in Indonesia in early March 2020 and restarted after adjustments including the COVID-19 prevention protocols were made to adapt to the pandemic era in line with international and national health organizations guideline. The profile, trend, changes for adaptation and safety in regards to preventing COVID-19 infection to the patients of the living donation KT procedures in Indonesia during the pandemic era is not well recorded. Therefore, this study aims to collect and report the data.

Method: In a retrospective cohort study, the detailed report and scheduling of KT procedures from January 2020 to January 2022 in Dr. Cipto Mangunkusumo Hospital and Asri Hospital, Jakarta, Indonesia were collected and assessed to look for the number of performed KT in Indonesia before and during the pandemic era. The data of KT in both hospitals after the program restarted during the pandemic era from May 2020 to January 2022 was the focus of evaluation.

Results: An average of 9,67 KT procedures/month were performed in January-March 2020. No KT procedures were performed in April 2020. 3 KT procedures were done in May 2020 as the KT program was restarted. An average of 8,95 KT procedures/month were performed in May 2020-January 2022. Out of 208 KT schedules from May 2020 to January 2022, 188 KTs were performed on schedule, 13 were rescheduled or cancelled due to clinical conditions other than COVID-19, while 7 (3,37%) were due to patient’s COVID-19 infection confirmed by PCR during the preoperative hospital stay. 55,32% of donors and 68,09% of recipients were male. Only 5,85% of recipients were paediatrics while the rest were adults. Starting from October 2020, 100% of the laparoscopic approach has been shifted to retroperitoneal from transperitoneal in purpose to minimize the risk of COVID-19 infection from patient to medical staff. Based on the data from Dr. Cipto Mangunkusumo Hospital only, 94% of KT recipients stay uninfected by COVID-19 following their KT procedure until this study is performed, while 6 recipients were infected in which 2 were infected during 14-28 days after the procedure and 4 were infected at more than 14-28 days after.

Conclusion: Indonesia KT centres succeeded to overcome the COVID-19 pandemic situation and is back to safely performing the same normal amount of KT procedures monthly as before the pandemic. The success is the result of some adaptations including COVID-19 screening protocols for the medical staff and patients and a change in the laparoscopic approach.