Re-initiating living donor kidney transplantation in the COVID-19 pandemic: the Indonesian experience

Introduction: Kidney transplantation (KT) was significantly impacted by the COVID-19 pandemic, with most centers halting living donor programs. In Indonesia, KT programs in Jakarta were suspended in April 2020, shortly after the first national COVID-19 case. Programs resumed following protocol adjustments aligned with international and national guidelines. However, data on trends, safety adaptations, and COVID-19 infection prevention among living donor KT recipients during the pandemic remain limited. This study aims to report these findings. Method: A retrospective cohort study was conducted using KT scheduling and procedure data from Dr. Cipto Mangunkusumo Hospital and Asri Hospital, Jakarta, from January 2020 to June 2023. Special focus was given to the post-restart period (May 2020–June 2023) to assess KT procedure trends and infection control outcomes. Results: From January to March 2020, an average of 9.67 KT procedures/month were performed. No KT occurred in April 2020. After resuming in May 2020, 3 KT procedures were conducted, followed by an average of 10/month through June 2023. Of 404 scheduled KTs, 382 were performed on time. Thirteen were postponed due to non-COVID-19 clinical issues, and nine (2.23%) due to confirmed COVID-19 infections. Most donors (60.64%) and recipients (71.29%) were male; 3.96% of recipients were pediatric. From October 2020, all laparoscopic procedures shifted to a retroperitoneal approach to reduce transmission risk. At Dr. Cipto Mangunkusumo Hospital, 97% of KT recipients remained uninfected post-procedure; six were infected later, two within 14–28 days and four beyond. Conclusion: KT centers in Indonesia successfully adapted to pandemic challenges and now perform more procedures than before COVID-19. Success was supported by surgical approach modifications and enhanced screening protocols.