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Ann Liver Transplant 2022; 2(1): 15-20
Published online May 31, 2022 https://doi.org/10.52604/alt.22.0002
Copyright © The Korean Liver Transplantation Society.
Yong-Kyu Chung1 
, Sung-Hwa Kang2
Correspondence to:Yong-Kyu Chung
Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeun-daero, Haeundae-gu, Busan 48108, Korea
E-mail: iteacher13@gmail.com
https://orcid.org/0000-0002-2132-2450
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/bync/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Coronavirus disease 2019 (COVID-19) pandemic had serious effects on the healthcare system and has led to decrease in organ transplantation. Since the prevalence of COVID-19 in Korea was much lower than in Western countries, we analyzed the influence of COVID-19 on organ donation and transplantation in Korea.
Methods: The annual number of kidney transplantation (KT) and liver transplantation (LT) in 2020–2021 were compared with those in 2019 using data from Korean Network for Organ Sharing database.
Results: The number of deceased donors (DD) was 450 in 2019, 478 in 2020 and 442 in 2021; their average monthly number was 37.5±5.9 in 2019, 39.8±4.4 in 2020, and 36.8±6.4 in 2021 (p≥0.284). The annual case number of DDLT was 391 in 2019, 395 in 2020 and 357 in 2021; their monthly case number was 32.6±5.7, 32.9±4.7, and 29.8±3.6, respectively (p≥0.161). The annual case number of DDKT was 794, 848, and 747, respectively; their average monthly case number was 66.1±10.4, 70.7±9.8, and 62.3±12.2, respectively (p≥0.285). The annual case number of LDLT was 1,577, 1,146, and 1,126, respectively; their average monthly case number was 131.4±18.1, 95.5±8.0, and 93.8±8.9, respectively (p<0.001). The annual case number of LDKT was 2,293, 1,432, and 1,445, respectively; their average monthly case number was 191.1±19.5, 119.3±11.7, and 120.4±14.9, respectively (p<0.001).
Conclusion: The results of this study indicate that, in Korea, the number of DDLT and DDKT remained stable during 2020–2021, but those of LDLT and LDKT were significantly reduced in Korea during the two-year of the COVID-19 pandemic.
Keywords: Corona virus disease 19, Deceased donor, Living donors, Organ transplantation, Donation promotion
The coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), pandemic has impacted all the facets of the health care system, including life-saving procedures such as organ transplantation. Concerns for potential exposure to the causative SARS-CoV-2 have profoundly altered the process of organ donation and recovery that is vital to organ transplantation [1-4]. In the year 2020, COVID-19 has had a substantial impact on the transplant community. The risk of virus transmission from the donors to recipients or from the donors to health care workers posed a new challenge of safely recovering organs and performing organ transplantation. In addition, the dramatic increase in COVID-19 infections led to a significant decrease in the number of deceased donors and organ transplantations in Western countries [4-9]. On the contrary, the prevalence of COVID-19 and the number of critically ill patients were much lower in Korea than in the Western countries [10-12]. As a result, the number of deceased donor liver transplantation (DDLT) and deceased donor kidney transplantation (DDKT) remained stable in Korea during the year 2020, but those of living donor liver transplantation (LDLT) and living donor kidney transplantation (LDKT) were significantly reduced [13].
COVID-19 pandemic has been persistently prevalent over the recent two years, and therefore it is necessary to evaluate its effect on the number of organ donation and transplantation during the years 2020–2021 in Korea. The present study aimed to determine the number of deceased organ donors, and kidney and liver transplantations during the period of years 2020–2021 using data from the Korean Network for Organ Sharing (KONOS) database.
This study aimed to determine the annual number of kidney and liver transplantations that were performed in Korea during the period of years 2020 and 2021. We compared the annual number of kidney and liver transplantations performed in the years 2020–2021 with those that performed in the year 2019 by using the data from the KONOS database.
The study protocol was waived for approval by the Institutional Review Board due to the nature of the data, the publicly open data. This study was performed in accordance with the ethical guidelines of the World Medical Association Declaration of Helsinki 2013.
Student t-test was performed to compare the number of organ donation and transplantation. A p-value <0.05 was considered to be statistically significant. All statistical analyses were performed using SPSS version 22 (IBM Corp., Armonk, NY, USA).
During the 11-year period from January 2011 to December 2021, the total number of deceased organ donors was 5,047. The annual incidences of deceased donors, DDLT and DDKT are depicted in Fig. 1.
Figure 1.The annual incidence of deceased donors and deceased donor organ transplantation in Korea from January 2011 to December 2021. DDLT, deceased donor liver transplantation; DDKT, deceased donor kidney transplantation.
The annual number of deceased donors was 450 in the year 2019, 478 in the year 2020, and 442 in the year 2021. The average monthly case number of deceased donors was 37.5±5.9 in the year 2019, 39.8±4.4 in the year 2020, and 36.8±6.4 in the year 2021 (p=0.284 between 2019 and 2020; p=0.792 between 2019 and 2021, Fig. 2).
Figure 2.Comparison of the monthly incidences of deceased donors during the years 2019–2021 in Korea.
The annual case number of DDLT was 391 in the year 2019, 395 in the year 2020 and 357 in the year 2021. The average monthly case number of DDLT was 32.6±5.7 in the year 2019, 32.9±4.7 in the year 2020, and 29.8±3.6 in the year 2021 (p=0.877 between 2019 and 2020; p=0.161 between 2019 and 2021; Fig. 3A).
Figure 3.Comparison of the monthly incidences of deceased donor liver transplantation (DDLT) (A) deceased donor kidney transplantation (DDKT) (B) and during the years 2019–2021 in Korea.
The annual case number of DDKT was 794 in the year 2019, 848 in the year 2020, and 747 in the year 2021. The average monthly case number of DDKT was 66.1±10.4 in the year 2019, 70.7±9.8 in the year 2020, and 62.3±12.2 in the year 2021 (p=0.285 between 2019 and 2020; p=0.405 between 2019 and 2021; Fig. 3B).
The annual case number of LDLT was 1,577 in the year 2019, 1,146 in the year 2020, and 1,126 in the year 2021, respectively. The average monthly case number of LDLT was 131.4±18.1 in the year 2019, 95.5±8.0 in the year 2020, and 93.8±8.9 in the year 2021 (p<0.001 between 2019 and 2020; p<0.001 between 2019 and 2021; Fig. 4A).
Figure 4.Comparison of the monthly incidences of living donor liver transplantation (LDLT) (A) and living donor kidney transplantation (LDKT) (B) during the years 2019–2021 in Korea.
The annual case number of LDKT was 2,293 in the year 2019, 1,432 in the year 2020, and 1,445 in the year 2021. The average monthly case number of LDKT was 191.1±19.5 in the year 2019, 119.3±11.7 in the year 2020, and 120.4±14.9 in the year 2021 (p<0.001 between 2019 and 2020; p<0.001 between 2019 and 2021; Fig. 4B).
The annual case numbers of DDLT, DDKT, LDLT, and LDKT were collectively compared in Fig. 5.
Figure 5.Comparison of the number of the deceased and living donor kidney and liver transplantations during the years 2019–2021 in Korea. DDLT, deceased donor liver transplantation; LDLT, living donor liver transplantation; DDKT, deceased donor kidney transplantation; LDKT, living donor kidney transplantation.
The World Health Organization (WHO) declared COVID- 19 as a global pandemic as it spread rapidly throughout the world. Since there is no effective treatment for COVID-19, the risk of COVID-19 is high in patients awaiting organ transplant surgery that is performed to treat end-stage organ diseases. As the pandemic worsens around the world for more than two years, the number of organs recovered from deceased donors has decreased. Living donor organ transplantation has been postponed to preserve medical resources for COVID-19 and to avoid nosocomial infection, resulting in a significant decrease in the number of organ transplantation [4-8].
The results of the present study indicate that, in Korea, the numbers of deceased donors and DDKT/DDLT were not significantly decreased during the years 2020-2021. On the other hand, the number of LDKT and LDLT significantly decreased in Korea during the two years of COVID-19 pandemic, compared with data of the year 2019. The transplantation activities in Asan Medical Center and Severance Hospital were reported to be remained stable during the year 2020, as compared to the year 2019 [13,14].
The burden of COVID-19 pandemic has overwhelmed the healthcare system in Western countries, and severely declined organ donation and transplantations. In the United States of America (USA), a short-term analysis was conducted on the impact of COVID-19 on organ transplantation. The results indicated a strong temporal association between an increase in COVID-19 infections and a striking reduction in the overall number of solid-organ transplantation procedures [8,9]. This declining effect was also observed in several European countries [4-9]. Following the outbreak of COVID-19, the overall reduction in deceased donor transplantations was 90.6% in France and 51.1% in the USA, respectively [8]. In both France and the USA, this reduction was mostly observed in the number of kidney transplantation [9].
Notably, the impacts of COVID-19 pandemic on organ transplantation have been different between Western countries and Korea. This is primarily because the prevalence of COVID-19 in the general population and the number of critically ill patients were much higher in the Western countries than in Korea. A Korean epidemiologic study revealed that the national COVID-19 death rate was 2.3 per 100,000 [10,13], which is significantly lower than that of the Western countries [11,12].
Patients with chronic liver disease, especially liver cirrhosis, have higher morbidity and mortality from COVID-19 than patients without liver disease. Notably, there has not been a consistent increase in mortality in liver transplant recipients, in whom severe disease among them is more strongly associated with advanced age and medical comorbidities, rather than with transplant-specific factors. While several targeted COVID-19 therapies have reported hepatotoxicity, these therapies may be safe and effective in patients with liver disease and liver transplant recipients. Questions remain regarding whether SARS-CoV-2 can be transmitted via the donor’s liver and whether a transplant is safe in patients and/or donors with recent or active COVID-19. Consequently, together with other COVID-19 related challenges, the donor liver safety concerns have significantly affected the care of liver transplant candidates and recipients, and guidelines for the safe practice of liver transplantation are rapidly evolving [15-24].
This study has several limitations of note. This was a retrospective cohort study with limited information on donors and recipients, because detailed data were not available in the KONOS database. The results of this study need to be validated by conducting yearly follow-up studies, including further analysis of near-future data.
In conclusion, the results of this study indicate that, in Korea, the number of DDLT and DDKT remained stable during the years 2020-2021, but those of LDLT and LDKT were significantly reduced during the two years of COVID-19 pandemic. Further studies are necessary to validate the results of this study.
There was no funding related to this study.
All authors have no conflicts of interest to declare.
Conceptualization: All. Data curation: All. Methodology: All. Visualization: YKC. Writing - original draft: All. Writing - review & editing: All.
Ann Liver Transplant 2022; 2(1): 15-20
Published online May 31, 2022 https://doi.org/10.52604/alt.22.0002
Copyright © The Korean Liver Transplantation Society.
Yong-Kyu Chung1 , Sung-Hwa Kang2
1Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
2Department of Surgery, Dong-A University Hospital, College of Medicine, Dong-A University, Busan, Korea
Correspondence to:Yong-Kyu Chung
Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeun-daero, Haeundae-gu, Busan 48108, Korea
E-mail: iteacher13@gmail.com
https://orcid.org/0000-0002-2132-2450
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/bync/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Coronavirus disease 2019 (COVID-19) pandemic had serious effects on the healthcare system and has led to decrease in organ transplantation. Since the prevalence of COVID-19 in Korea was much lower than in Western countries, we analyzed the influence of COVID-19 on organ donation and transplantation in Korea.
Methods: The annual number of kidney transplantation (KT) and liver transplantation (LT) in 2020–2021 were compared with those in 2019 using data from Korean Network for Organ Sharing database.
Results: The number of deceased donors (DD) was 450 in 2019, 478 in 2020 and 442 in 2021; their average monthly number was 37.5±5.9 in 2019, 39.8±4.4 in 2020, and 36.8±6.4 in 2021 (p≥0.284). The annual case number of DDLT was 391 in 2019, 395 in 2020 and 357 in 2021; their monthly case number was 32.6±5.7, 32.9±4.7, and 29.8±3.6, respectively (p≥0.161). The annual case number of DDKT was 794, 848, and 747, respectively; their average monthly case number was 66.1±10.4, 70.7±9.8, and 62.3±12.2, respectively (p≥0.285). The annual case number of LDLT was 1,577, 1,146, and 1,126, respectively; their average monthly case number was 131.4±18.1, 95.5±8.0, and 93.8±8.9, respectively (p<0.001). The annual case number of LDKT was 2,293, 1,432, and 1,445, respectively; their average monthly case number was 191.1±19.5, 119.3±11.7, and 120.4±14.9, respectively (p<0.001).
Conclusion: The results of this study indicate that, in Korea, the number of DDLT and DDKT remained stable during 2020–2021, but those of LDLT and LDKT were significantly reduced in Korea during the two-year of the COVID-19 pandemic.
Keywords: Corona virus disease 19, Deceased donor, Living donors, Organ transplantation, Donation promotion
The coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), pandemic has impacted all the facets of the health care system, including life-saving procedures such as organ transplantation. Concerns for potential exposure to the causative SARS-CoV-2 have profoundly altered the process of organ donation and recovery that is vital to organ transplantation [1-4]. In the year 2020, COVID-19 has had a substantial impact on the transplant community. The risk of virus transmission from the donors to recipients or from the donors to health care workers posed a new challenge of safely recovering organs and performing organ transplantation. In addition, the dramatic increase in COVID-19 infections led to a significant decrease in the number of deceased donors and organ transplantations in Western countries [4-9]. On the contrary, the prevalence of COVID-19 and the number of critically ill patients were much lower in Korea than in the Western countries [10-12]. As a result, the number of deceased donor liver transplantation (DDLT) and deceased donor kidney transplantation (DDKT) remained stable in Korea during the year 2020, but those of living donor liver transplantation (LDLT) and living donor kidney transplantation (LDKT) were significantly reduced [13].
COVID-19 pandemic has been persistently prevalent over the recent two years, and therefore it is necessary to evaluate its effect on the number of organ donation and transplantation during the years 2020–2021 in Korea. The present study aimed to determine the number of deceased organ donors, and kidney and liver transplantations during the period of years 2020–2021 using data from the Korean Network for Organ Sharing (KONOS) database.
This study aimed to determine the annual number of kidney and liver transplantations that were performed in Korea during the period of years 2020 and 2021. We compared the annual number of kidney and liver transplantations performed in the years 2020–2021 with those that performed in the year 2019 by using the data from the KONOS database.
The study protocol was waived for approval by the Institutional Review Board due to the nature of the data, the publicly open data. This study was performed in accordance with the ethical guidelines of the World Medical Association Declaration of Helsinki 2013.
Student t-test was performed to compare the number of organ donation and transplantation. A p-value <0.05 was considered to be statistically significant. All statistical analyses were performed using SPSS version 22 (IBM Corp., Armonk, NY, USA).
During the 11-year period from January 2011 to December 2021, the total number of deceased organ donors was 5,047. The annual incidences of deceased donors, DDLT and DDKT are depicted in Fig. 1.
Figure 1. The annual incidence of deceased donors and deceased donor organ transplantation in Korea from January 2011 to December 2021. DDLT, deceased donor liver transplantation; DDKT, deceased donor kidney transplantation.
The annual number of deceased donors was 450 in the year 2019, 478 in the year 2020, and 442 in the year 2021. The average monthly case number of deceased donors was 37.5±5.9 in the year 2019, 39.8±4.4 in the year 2020, and 36.8±6.4 in the year 2021 (p=0.284 between 2019 and 2020; p=0.792 between 2019 and 2021, Fig. 2).
Figure 2. Comparison of the monthly incidences of deceased donors during the years 2019–2021 in Korea.
The annual case number of DDLT was 391 in the year 2019, 395 in the year 2020 and 357 in the year 2021. The average monthly case number of DDLT was 32.6±5.7 in the year 2019, 32.9±4.7 in the year 2020, and 29.8±3.6 in the year 2021 (p=0.877 between 2019 and 2020; p=0.161 between 2019 and 2021; Fig. 3A).
Figure 3. Comparison of the monthly incidences of deceased donor liver transplantation (DDLT) (A) deceased donor kidney transplantation (DDKT) (B) and during the years 2019–2021 in Korea.
The annual case number of DDKT was 794 in the year 2019, 848 in the year 2020, and 747 in the year 2021. The average monthly case number of DDKT was 66.1±10.4 in the year 2019, 70.7±9.8 in the year 2020, and 62.3±12.2 in the year 2021 (p=0.285 between 2019 and 2020; p=0.405 between 2019 and 2021; Fig. 3B).
The annual case number of LDLT was 1,577 in the year 2019, 1,146 in the year 2020, and 1,126 in the year 2021, respectively. The average monthly case number of LDLT was 131.4±18.1 in the year 2019, 95.5±8.0 in the year 2020, and 93.8±8.9 in the year 2021 (p<0.001 between 2019 and 2020; p<0.001 between 2019 and 2021; Fig. 4A).
Figure 4. Comparison of the monthly incidences of living donor liver transplantation (LDLT) (A) and living donor kidney transplantation (LDKT) (B) during the years 2019–2021 in Korea.
The annual case number of LDKT was 2,293 in the year 2019, 1,432 in the year 2020, and 1,445 in the year 2021. The average monthly case number of LDKT was 191.1±19.5 in the year 2019, 119.3±11.7 in the year 2020, and 120.4±14.9 in the year 2021 (p<0.001 between 2019 and 2020; p<0.001 between 2019 and 2021; Fig. 4B).
The annual case numbers of DDLT, DDKT, LDLT, and LDKT were collectively compared in Fig. 5.
Figure 5. Comparison of the number of the deceased and living donor kidney and liver transplantations during the years 2019–2021 in Korea. DDLT, deceased donor liver transplantation; LDLT, living donor liver transplantation; DDKT, deceased donor kidney transplantation; LDKT, living donor kidney transplantation.
The World Health Organization (WHO) declared COVID- 19 as a global pandemic as it spread rapidly throughout the world. Since there is no effective treatment for COVID-19, the risk of COVID-19 is high in patients awaiting organ transplant surgery that is performed to treat end-stage organ diseases. As the pandemic worsens around the world for more than two years, the number of organs recovered from deceased donors has decreased. Living donor organ transplantation has been postponed to preserve medical resources for COVID-19 and to avoid nosocomial infection, resulting in a significant decrease in the number of organ transplantation [4-8].
The results of the present study indicate that, in Korea, the numbers of deceased donors and DDKT/DDLT were not significantly decreased during the years 2020-2021. On the other hand, the number of LDKT and LDLT significantly decreased in Korea during the two years of COVID-19 pandemic, compared with data of the year 2019. The transplantation activities in Asan Medical Center and Severance Hospital were reported to be remained stable during the year 2020, as compared to the year 2019 [13,14].
The burden of COVID-19 pandemic has overwhelmed the healthcare system in Western countries, and severely declined organ donation and transplantations. In the United States of America (USA), a short-term analysis was conducted on the impact of COVID-19 on organ transplantation. The results indicated a strong temporal association between an increase in COVID-19 infections and a striking reduction in the overall number of solid-organ transplantation procedures [8,9]. This declining effect was also observed in several European countries [4-9]. Following the outbreak of COVID-19, the overall reduction in deceased donor transplantations was 90.6% in France and 51.1% in the USA, respectively [8]. In both France and the USA, this reduction was mostly observed in the number of kidney transplantation [9].
Notably, the impacts of COVID-19 pandemic on organ transplantation have been different between Western countries and Korea. This is primarily because the prevalence of COVID-19 in the general population and the number of critically ill patients were much higher in the Western countries than in Korea. A Korean epidemiologic study revealed that the national COVID-19 death rate was 2.3 per 100,000 [10,13], which is significantly lower than that of the Western countries [11,12].
Patients with chronic liver disease, especially liver cirrhosis, have higher morbidity and mortality from COVID-19 than patients without liver disease. Notably, there has not been a consistent increase in mortality in liver transplant recipients, in whom severe disease among them is more strongly associated with advanced age and medical comorbidities, rather than with transplant-specific factors. While several targeted COVID-19 therapies have reported hepatotoxicity, these therapies may be safe and effective in patients with liver disease and liver transplant recipients. Questions remain regarding whether SARS-CoV-2 can be transmitted via the donor’s liver and whether a transplant is safe in patients and/or donors with recent or active COVID-19. Consequently, together with other COVID-19 related challenges, the donor liver safety concerns have significantly affected the care of liver transplant candidates and recipients, and guidelines for the safe practice of liver transplantation are rapidly evolving [15-24].
This study has several limitations of note. This was a retrospective cohort study with limited information on donors and recipients, because detailed data were not available in the KONOS database. The results of this study need to be validated by conducting yearly follow-up studies, including further analysis of near-future data.
In conclusion, the results of this study indicate that, in Korea, the number of DDLT and DDKT remained stable during the years 2020-2021, but those of LDLT and LDKT were significantly reduced during the two years of COVID-19 pandemic. Further studies are necessary to validate the results of this study.
There was no funding related to this study.
All authors have no conflicts of interest to declare.
Conceptualization: All. Data curation: All. Methodology: All. Visualization: YKC. Writing - original draft: All. Writing - review & editing: All.
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