To the editor:
We read with interest the article by Banerjee et al. 1 reporting 7 cases of coronavirus disease 2019 (COVID-19) in kidney transplant recipients. Banerjee et al. 1 raised concerns about increased susceptibility to COVID-19 infection during the postoperative period; however, the impact of immunosuppression on susceptibility to COVID-19 remains unknown. Recent data on clinical outcomes of COVID-19 infection in kidney transplant patients are conflicting.2 Furthermore, some preliminary reports suggest the reduced immune response due to immunosuppression may provide a protective effect against severe COVID-19.3
South Korea was one of the earliest countries to experience the COVID-19 outbreak, quickly becoming the country with the second highest number of COVID-19 infections after China. In response, South Korea carried out extensive virus testing and contact tracing. In cooperation with national-level efforts, most transplant programs adopted universal donor and recipient screening using reverse transcriptase polymerase chain reaction, in accordance with the Korean Transplantation Society recommendation. Thus, national kidney transplant activities in South Korea remained stable for both living and deceased donor transplantation compared with the same period during the previous year (Table 1 ).
Table 1.
Kidney transplant activities in South Korea during the COVID-19 outbreak
| January 1 to April 30, 2019 | January 1 to April 30, 2020 | Changes in transplant activities (%) | |
|---|---|---|---|
| Deceased donors, n | 152 | 162 | +6.6 |
| Kidney transplants, n | 757 | 774 | +2.2 |
| Living donor | 493 (65.1) | 473 (61.1) | −4.1 |
| Deceased donor | 264 (34.9) | 301 (38.9) | +14.0 |
| Age, yr | |||
| <40 | 152 (20.1) | 145 (18.7) | −4.6 |
| 40–49 | 178 (23.5) | 190 (24.6) | +6.7 |
| 50–59 | 278 (36.7) | 249 (32.2) | −10.4 |
| 50–69 | 134 (17.7) | 169 (21.8) | +26.1 |
| ≥70 | 15 (2.0) | 21 (2.7) | +40.0 |
COVID-19, coronavirus disease 2019.
Values are n (%) unless otherwise indicated. Data are from the Korean Network for Organ Sharing.
During these unprecedented times, little is known about the safety of kidney transplantation. However, delaying or halting of kidney transplantation is not a safe option for patients with end-stage renal disease. Because they still require lifesaving dialysis during the pandemic, these vulnerable patients are unable to practice social distancing and must travel to dialysis facilities.4 Therefore, we should carefully weigh the risks and benefits of pursuing or postponing kidney transplantation, considering immediate medical circumstances.
References
- 1.Banerjee D., Popoola J., Shah S. COVID-19 infection in kidney transplant recipients. Kidney Int. 2020;97:1076–1082. doi: 10.1016/j.kint.2020.03.018. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.The Columbia University Kidney Transplant Program. Early description of coronavirus 2019 disease in kidney transplant recipients in New York. J Am Soc Nephrol. 2020;31:1150–1156. [DOI] [PMC free article] [PubMed]
- 3.D’Antiga L. Coronaviruses and immunosuppressed patients: the facts during the third epidemic. Liver Transpl. 2020;26:832–934. doi: 10.1002/lt.25756. [DOI] [PubMed] [Google Scholar]
- 4.Kliger AS, Cozzolino M, Jha V, et al. Managing the COVID-19 pandemic: international comparisons in dialysis patients. Kidney Int. 2020;98:12–16. [DOI] [PMC free article] [PubMed]