Tesis

Re-initiating living donation kidney transplantation in COVID- 19 pandemic: Indonesia Experience = Menginisiasi Kembali Transplantasi Ginjal Donor Hidup pada Masa Pandemi COVID-19: Pengalaman di Indonesia.

Introduction Kidney transplantation (KT) is one of many health care procedures impacted by the COVID-19 pandemic and most KT centres decided to withhold their program, especially living kidney transplantation. With 45 years of experience, the KT program in Indonesia’s KT centres in Jakarta was also stopped for a month in April 2020 due to uncertain conditions after the first COVID-19 case was detected in Indonesia in early March 2020 and restarted after adjustments including the COVID-19 prevention protocols were made to adapt to the pandemic era in line with international and national health organizations guideline. The profile, trend, changes for adaptation and safety in regards to preventing COVID-19 infection to the patients of the living donation KT procedures in Indonesia during the pandemic era is not well recorded. Therefore, this study aims to collect and report the data. Method In a retrospective cohort study, the detailed report and scheduling of KT procedures from January 2020 to January 2022 in Dr. Cipto Mangunkusumo Hospital and Asri Hospital, Jakarta, Indonesia were collected and assessed to look for the number of performed KT in Indonesia before and during the pandemic era. The data of KT in both hospitals after the program restarted during the pandemic era from May 2020 to June 2023 was the focus of evaluation. Results An average of 9,67 KT procedures/month were performed in January-March 2020. No KT procedures were performed in April 2020. 3 KT procedures were done in May 2020 as the KT program was restarted. An average of 10 KT procedures/month were performed in May 2020- June 2023. Out of 404 KT schedules from May 2020 to June 2023, 382 KTs were performed on schedule, 13 were rescheduled due to clinical conditions other than COVID-19, while 9 (2,23%) were due to patient’s COVID-19 infection confirmed by PCR during the preoperative hospital stay. 60,64% of donors and 71,29% of recipients were male. Only 3,96% of recipients were paediatrics while the rest were adults. Starting from October 2020, 100% of the laparoscopic approach has been shifted to retroperitoneal from transperitoneal in purpose to minimize the risk of COVID-19 infection from patient to medical staff. Based on the data from Dr. Cipto Mangunkusumo Hospital only, 97% of KT recipients stay uninfected by COVID-19 following their KT procedure until this study is performed, while 6 recipients were infected in which 2 were infected during 14-28 days after the procedure and 4 were infected at more than 14-28 days after. Conclusion Indonesia KT centres succeeded to overcome the COVID-19 pandemic situation and are now again firmly performing more KT procedures each month than they were doing before the pandemic. The success is due to several adjustments, such as change in the laparoscopic approach and COVID-19 screening protocols for patients and medical staff.


Pendahuluan Transplantasi ginjal merupakan salah satu prosedur layanan kesehatan yang terdampak oleh pandemi COVID-19, dan sebagian besar pusat transplantasi ginjal memutuskan untuk menghentikan program mereka, khususnya transplantasi ginjal donor hidup. Dengan pengalaman selama 45 tahun, program transplantasi ginjal di pusat-pusat transplantasi ginjal di Jakarta, Indonesia juga sempat dihentikan selama satu bulan pada April 2020 akibat ketidakpastian setelah kasus COVID-19 pertama terdeteksi di Indonesia pada awal Maret 2020, dan kemudian dimulai kembali setelah dilakukan penyesuaian termasuk penerapan protokol pencegahan COVID-19 untuk beradaptasi dengan era pandemi sesuai pedoman organisasi kesehatan internasional dan nasional. Profil, tren, perubahan untuk adaptasi, dan aspek keselamatan terkait pencegahan infeksi COVID-19 pada pasien prosedur KT donor hidup di Indonesia selama era pandemi belum tercatat dengan baik. Oleh karena itu, penelitian ini bertujuan untuk mengumpulkan dan melaporkan data tersebut. Metode Dalam studi kohort retrospektif, laporan detail dan jadwal prosedur transplantasi ginjal dari Januari 2020 hingga Januari 2022 di Rumah Sakit Dr. Cipto Mangunkusumo dan RS Asri, Jakarta, Indonesia dikumpulkan dan dievaluasi untuk melihat jumlah transplantasi ginjal yang dilakukan di Indonesia sebelum dan selama era pandemi. Data transplantasi ginjal di kedua rumah sakit setelah program dimulai kembali pada era pandemi, yaitu dari Mei 2020 hingga Juni 2023, menjadi fokus evaluasi. Hasil Rata-rata 9,67 prosedur transplantasi ginjal /bulan dilakukan pada Januari–Maret 2020. Tidak ada prosedur transplantasi ginjal yang dilakukan pada April 2020. Tiga prosedur transplantasi ginjal dilakukan pada Mei 2020 ketika program transplantasi ginjal dimulai kembali. Rata-rata 10 prosedur transplantasi ginjal /bulan dilakukan pada Mei 2020–Juni 2023. Dari 404 jadwal transplantasi ginjal pada Mei 2020–Juni 2023, 382 transplantasi ginjal dilakukan sesuai jadwal, 13 dijadwalkan ulang karena kondisi klinis lain selain COVID-19, sementara 9 (2,23%) dijadwalkan ulang akibat infeksi COVID-19 pada pasien yang terkonfirmasi melalui PCR selama masa rawat inap prabedah. Sebanyak 60,64% donor dan 71,29% resipien adalah laki-laki. Hanya 3,96% resipien adalah pasien pediatrik, sisanya adalah dewasa. Mulai Oktober 2020, pendekatan laparoskopi 100% dialihkan dari transperitoneal ke retroperitoneal dengan tujuan meminimalkan risiko penularan COVID-19 dari pasien ke petugas medis. Berdasarkan data dari RS Dr. Cipto Mangunkusumo saja, 97% resipien transplantasi ginjal tetap tidak terinfeksi COVID-19 setelah prosedur transplantasi ginjal hingga penelitian ini dilakukan, sementara 6 resipien terinfeksi—2 di antaranya dalam 14–28 hari setelah prosedur dan 4 pada lebih dari 28 hari setelah prosedur. Kesimpulan Pusat-pusat transplantasi ginjal di Indonesia berhasil mengatasi situasi pandemi COVID-19 dan kini kembali mampu melakukan lebih banyak prosedur transplantasi ginjal setiap bulan dibandingkan sebelum pandemi. Keberhasilan ini dicapai berkat sejumlah penyesuaian, seperti perubahan pendekatan laparoskopi dan protokol skrining COVID-19 bagi pasien dan tenaga medis.