Korean J Transplant.  2021 Dec;35(4):218-229. 10.4285/kjt.21.0024.

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

  • 1Department 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


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.
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.
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.
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.


Kidney transplantation; COVID-19; Asia; Registry
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