Impact of COVID-19 era, nation's economic status, vaccination status, vaccine doses and new COVID-19 therapeutics on mortality from COVID-19 infections in kidney transplant recipients from Asia: an Asian society of transplantation research group (ASTREGO) analysis
Terence Kee1,2, Jong Cheol Jeong 3, Mel Hatra Arakama4, Tseren Khishgee5, Min Hui Tan 6, Vaibhav Tiwari7, Nura Afza Salma Begum8, Ni Made Hustrini9, Maisarah Binti Jalalonmuhali10, Si Yen Tan11, Jackson Tan12, Yaerim Kim13, Becky Ma Mingyao14, Hersharan Kaur Sran15, Ghazali Ahmad16.
1SingHealth Duke-NUS Transplant Centre, Singapore General Hospital , Singapore, Singapore; 2Renal Medicine , Singapore General Hospital , Singapore, Singapore; 3Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; 4Nephrology , National Kidney and Transplant Institute , Quezon City, Philippines; 5Kidney and Organ Transplantation Center, The First Central Hospital of Mongolia, Ulaanbaatar, Mongolia; 6Nephrology , Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; 7Nephrology, Sir Ganga Ram Hospital, New Delhi, India; 8Nephrology, Kidney Foundation Hospital and Research Institute , Dhaka, Bangladesh; 9Internal Medicine, Dr. Cipto Mangunkusumo National Hospital, Jakarta , Indonesia; 10Renal Medicine , University Malaya Medical Center, Kuala Lumpur, Malaysia; 11Nephrology and Transplant Services, Prince Court Medical Centre, Kuala Lumpur, Malaysia; 12Renal Services, RIPAS Hospital, Brunei Darussalam , Brunei Darussalam; 13Internal Medicine, Keimyung University School of Medicine, Daegu, Korea; 14Medicine, Queen Mary Hospital , Hong Kong, Hong Kong; 15National University Centre for Organ Transplantation, National University Hospital , Singapore, Singapore; 16Cardiology, National Heart Institute , Kuala Lumpur, Malaysia
Asian Society of Transplantation Research Group.
Background: Previous multinational studies of COVID-19 infections in kidney transplant recipients (KTX) from Asia suggest that the mortality rate is similar to that experienced in the West despite a younger population with lesser comorbidities. However, these studies were performed during the era where vaccination and better therapeutics for COVID-19 were not available. This multinational study from Asia seek to determine whether mortality of COVID-19 infected KTX have improved with different eras in vaccination and therapies.
Method: Data of 657 KTX from 15 transplant centres in Singapore (n=196), Philippines (n=115), Mongolia (n=106), Malaysia (n=86), India (n=67), Bangladesh (n=53), Indonesia (n=21), Brunei (n=9), South Korea (n=3) and Hong Kong (n=1) were obtained to determine the effect of COVID-19 era (2022 vs. 2020-2021), country’s economic status according to the new World Bank country classification system, vaccination status (vaccinated vs. non-vaccinated), number of vaccine doses given (3 dose vs. 1-2 doses) and new COVID-19 therapeutics that are known to prevent disease progression (Remdesivir and SARS-CoV-2 monoclonal antibodies) on mortality from COVID-19 infection.
Results: Mortality from COVID-19 infection in KTX has improved over the last 3 eras (30.3% in 2020 vs. 16.7% in 2021 vs. 0% for first 3 months of 2022; P<0.005) and was lowest among high income nations vs. lower income nations in Asia (0.5% vs. 20.9%; p<0.005). Mortality among vaccinated KTX was lower than non-vaccinated KTX (5.1% vs. 32.4%; p<0.005) as well as among those who received 3 doses versus those who received 0-2 doses of vaccine (3.2% vs. 21.4%; p<0.005). There was no significant difference in mortality in KTX who received Remdesivir vs. those who did not (16.9% vs. 12.7%; p=0.128) but mortality was lower among those received SARS-CoV2 monoclonal antibodies (0% vs. 16.8%; p<0.005). On multivariate analysis, low income nation status (OR 21.5; 95% CI 2.82-163.7) and 3 vaccine dose status (OR 0.24; 95% CI 0.11-0.53) were factors significantly associated with mortality.
Conclusion: This multinational study suggest that mortality has improved over time and with the introduction of COVID-19 vaccines and SARS-CoV-2 monoclonal antibody therapies. Receiving 3 doses of COVID-19 vaccine was associated with lower mortality while lower income nation status was associated with higher mortality. These findings suggest that increasing vaccine doses and improving pandemic response capabilities of healthcare systems are important in reducing death from COVID-19.
The Asian Transplant Registry Group include the leadership and support from Dr Romina Danguilan, Dr Rose Marie Liquete, Dr Lkhaakhuu Od-Erdene, Dr Rosnawati Yahya, Dr Devinder Singh Rana, Dr Harun Ur-Rashid, Dr Lim Soo Kun, Dr Maggie Ma Kam Man and Dr Curie Ahn from the Philippines, Mongolia, Malaysia, India, Bangladesh, Hong Kong and South Korea respectfully.
