pISSN 3022-6783
eISSN 3022-7712


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Korean J Transplant 2021; 35(4): 218-229

Published online December 31, 2021


© The Korean Society for Transplantation

Clinical characteristics, outcomes, and management of COVID-19 in kidney transplant recipients across Asia: an ASTREGO report

Terence Kee1 , Jong Cheol Jeong2 , Harun Ur-Rashid3 , Nura Afza Salma Begum3 , Mel-Hatra Arakama4 , Romina Danguilan4 , Lkhaahuu Od-Erdene5 , Rosnawati Yahya6 , Yaerim Kim7 , Hersharan Kaur Sran8 , Becky Ma9 , Maggie Ma9 , Devinder Singh Rana10 , Curie Ahn11 , Ghazali Ahmad12

1 Department of Renal Medicine, Singapore General Hospital and Kidney Transplant Program, SingHealth Duke-National University of Singapore Transplant Centre, Singapore
2Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
3Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
4Department of Nephrology, National Kidney and Transplant Institute, Quezon, Philippines
5Organ Transplantation Center, First Central Hospital, Ulaanbaatar, Mongolia
6Department of Nephrology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
7Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
8National University Centre for Organ Transplantation, National University Hospital, Singapore
9Department of Medicine, Queen Mary Hospital, Hong Kong
10Institute of Renal Sciences, Sir Ganga Ram Hospital, Delhi, India
11Department of Nephrology, Seoul National University College of Medicine, Seoul, Korea
12Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia

Correspondence to: Terence Kee
Department of Renal Medicine, Singapore General Hospital, Level 3, The Academia, 20 College Rd, Singapore 169586, Singapore
Tel: +65-63214436
Fax: +65-63214436
E-mail: terence.kee.y.s@singhealth.com.sg

Received: October 5, 2021; Revised: December 2, 2021; Accepted: December 3, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background: Asia is the global epicenter of the coronavirus disease 2019 (COVID-19) pandemic; however, COVID-19–related mortality in Asia remains lower than in other parts of the world. It is uncertain whether the mortality of COVID-19-infected kidney transplant recipients (KTXs) from Asia follows the lower mortality trends of the younger Asian population.
Methods: Specific transplant centers from countries in the Asian Society of Transplantation were invited to participate in a study to examine the epidemiology, clinical features, natural history, and outcomes of COVID-19 infections in KTXs. Data were analyzed and compared with those of large cohort studies from other countries.
Results: The study population was 87 KTXs from nine hospitals in seven Asian countries. Within the study population, 9% were aged 60 years and older, and 79% had at least one comorbidity. The majority of patients (69%) presented with mild-to-moderate COVID-19 severity. Disease progression was more frequently encountered among those with moderate or severe infection (23%) and non-survivors (55%). The mortality rate was 23% (n=20) and differed according to the level of care: 12% (n=1/8), 15% (n=10/67), and 100% (n=9/9) of patients managed as outpatients, in the general ward, and in the intensive care unit, respectively. Disease severity at the time of presentation was an independent predictor of mortality. Compared with the mortality rates in other studies worldwide, mortality rates in the current study were comparable.
Conclusions: Mortality in Asian KTXs who were infected with COVID-19 remains high and could be related to comorbidity burden and the constraints of the general healthcare system when the COVID-19 caseload is high.

Keywords: Kidney transplantation, COVID-19, Asia, Registry

  • This is the first multi-national Asian study of coronavirus disease 2019 (COVID-19) infections.

  • The study population comprised of younger kidney transplant recipients with a lower comorbidity burden.

  • Asymptomatic patients were frequent, but progression to more severe disease was uncommon.

  • Mortality from COVID-19 remained high despite a population likely to have a lower risk of progression.

  • There may be other factors affecting mortality in Asia such as timely access to higher levels of care.