key: cord-0819969-gt0nplp3 authors: Meshram, Dr. Hari Shankar; Kute, Dr. Vivek B.; Swarnalatha, Dr. G.; Hegde, Dr. Umapati; Sharma, Dr. Ashish; Sahay, Dr. Manisha; Guleria, Dr. Sandeep; Raju, Dr. Sree Bhushan; Eapen, Dr. Jeetu; Ray, Dr. Deepak S.; Chaudhary, Dr. Arpita Roy; Patel, Dr. Himanshu; S, Dr. Vishwanath; Pathak, Dr. Vivek; Agarwal, Dr. Dhananjay; Bahadur, Dr. M.M.; Verma, Dr. P.P.; Anandh, Dr. Urmila; Krishna, Dr. Amresh; Abraham, Dr. Abi; Mishra, Dr. Vineet title: Impact of COVID-19 in transplantation and nephrology in India: A nationwide report from India. date: 2021-10-02 journal: Transplant Proc DOI: 10.1016/j.transproceed.2021.09.008 sha: 382688df2cb2a5a9fad0628226b5e997380ccaae doc_id: 819969 cord_uid: gt0nplp3 Background The impact of COVID-19 in a developing nation is sparsely reported and more importantly the discrepancies in public and private sectors are underexplored. Methods We retrospectively investigated the data on the impact of COVID-19 on renal transplantation, between 2019-2020 in a nationwide analysis from 8 public and 10 private sector hospitals of India. Results On comparing the yearly data, the number of living-related transplants and deceased donor transplants declined by 48% (2610 vs 1370) and 49% (194 vs 99) respectively. The out-patient numbers and in-center admissions decreased by 40.4 % (6,16,741 vs 3,67,962) and 30.8 % (73,190 vs 49,918) respectively. There was no increase in the number of renal or graft biopsies in the COVID-19 era. The number of waitlisted patients on hemodialysis was higher in public (3,04,898 vs 3,38,343) when compared to private (1,63,096 vs 1,50,292) in the last 2 years. Similarly, the number of waitlisted patients on peritoneal dialysis (4655 vs 3526) was higher in public sector compared to private sector (932 vs 745). The decline in living transplants during the pandemic was higher in public setups (58%) compared to the private (49%). On the contrary, the decline in deceased donation was higher in private (57.9%) relative to public (50.6%). Conclusion COVID-19 has adversely affected the transplantation activities across the Indian transplantation centers, with a disproportionately higher impact on waitlisted patients in public sector programs. A sound prioritization of healthcare resources is mandated to safeguard the most deprived and high-risk waitlisted patients during the pandemic. respectively. There was no increase in the number of renal or graft biopsies in the COVID-19 era. The number of waitlisted patients on hemodialysis was higher in public (3,04,898 vs 3,38,343) when compared to private (1,63,096 vs 1,50,292) in the last 2 years. Similarly, the number of waitlisted patients on peritoneal dialysis (4655 vs 3526) was higher in public sector compared to private sector (932 vs 745). The decline in living transplants during the pandemic was higher in public setups (58%) compared to the private (49%). On the contrary, the decline in deceased donation was higher in private (57.9%) relative to public (50.6%). Conclusion: COVID-19 has adversely affected the transplantation activities across the Indian transplantation centers, with a disproportionately higher impact on waitlisted patients in public sector programs. A sound prioritization of healthcare resources is mandated to safeguard the most deprived and high-risk waitlisted patients during the pandemic. COVID-19 has reshaped transplantation activities across all parts of the world. 1, 2 Various high-level data are depicting the multi-domain effect of COVID-19 on transplantation practices. 3, 4 In the pandemic, an optimal assessment of the risk-benefit ratio for performing surgeries with an overburdened health care system is the most demanding step. 5 The next challenging step is to resume emergency transplantation in crisis, at least for the most vulnerable waitlisted patients. There have been numerous such reports from the developed nations, but there is a definite lack of such data from the developing world, where pandemic consequences were worse owing to underdeveloped healthcare resources. We aimed to analyze the crude impact of COVID-19 in transplantation services in India, where living donation predominates, unlike the western world. This report will provide a general illustration of the landscape of living renal transplantation in developing nations amid the COVID-19 pandemic. Hence, this report will help in prioritizing care for those sections of the transplantation system most prone to getting impacted negatively. India has a predominant living-related transplant program with the deceased donation in infancy and the bulk of transplantation occurs in private sector. 6 To measure the impact of the ongoing COVID-19 pandemic on transplantation and nephrology services in India, a nationwide call to 36 transplant centers was made. The data of 18 willing centers was Data from 18 centers (8 public and 10 private sector hospitals) was received and analyzed in the study. Due to the imposition of nationwide lockdown from April to June, there was an extremely steep decline in transplant and renal care activities. (Figure 1 -4 the difference was very small. The decline in living transplants during the pandemic was higher in public setups (58%) compared to the privates (49%). Contrary to that, the decline in deceased donation was higher in private (57.9%) relative to the public (50.6%) sector. Table 1 exhibits the comparison of the impact of COVID-19 between public and private transplant centers. There have been reports from the transplantation societies of many countries from the developed nations, 7 but the magnitude of impact in the Indian subcontinent is under-explored. Overall, the number of waitlisted patients in the pandemic year remained static, when compared to the gross decline in transplantation activity. Additionally, the number of waitlisted patients increased in public sector programs compared to the private sector. The long-term impact of the increased waiting time is also not known. The discrepancy found between public and private transplant centers has important implications and was understudied previously. Thus, the lower socioeconomic transplant candidates suffered more in the pandemic in our report. Furthermore, there was an absolute shut down of the activities in all centers at the peak of the pandemic. Deceased donation's contribution to Indian transplantation is already minuscule, and in the pandemic, it was amongst the most affected. Kidney paired donation is predominately a single-center experience in Indian settings. 8 In the pandemic, KPD rates also saw a drastic decline. One of the remarkable achievements of all the transplant centers was the successful transplantation of recovered patients which has been published in our previous reports. 9 Another highlight analysis from our report is the decline in in-center patients, which is attributed to the effective implementation of telemedicine in all the centers for tackling this pandemic, which proved an excellent tool in a densely populated nation with high transmission of COVID-19. There was no increase in the number of graft biopsies performed in the pandemic, which also suggests that COVID-19 may not have the postulated direct effects on kidneys 10 on a large scale. There was also no substantial increase in the number of patients on peritoneal dialysis patients, which shows the barriers of implementation and acceptability of this mode of dialysis which is regarded as having a theoretical advantage over hemodialysis in such a pandemic surge. The limitation of the report is that the detailed analysis of the mortality and in-hospital admission characteristics is not studied. In summary, our report highlights the impact of COVID-19 in transplantation in a developing nation and calls for channelizing the resources to the most deprived and high-risk patients to lessen the lethality of future pandemics. In this nationwide analysis, the public sector hospitals are more affected by the pandemic than private sector ones. Our report would help, in a better resource allocation by focusing on the most vulnerable part of the transplantation practices, especially in living donation. This will help in better preparedness and minimization of the damage, in case of a next COVID-19 wave. The impact of COVID-19 on kidney transplantation Consequences of the first and second COVID-19 wave on kidney transplant recipients at a large Indian transplant center Impact of COVID-19 on Lung Transplant Activity in Germany-A Cross-Sectional Survey COVID-19 and Solid Organ Transplantation: A Review Article A Multicenter Cohort Study From India of 75 Kidney Transplants in Recipients Recovered After COVID-19 Deceased-Donor Organ Transplantation in India: Current Status, Challenges, and Solutions Impact of COVID-19 in solid organ transplant recipients Non-simultaneous kidney exchange cycles in resource-restricted countries without non-directed donation -a prospective single-center cohort study A Multicenter Cohort Study From India of 75 Kidney Transplants in Recipients Recovered After COVID-19