Fadi Haidar1,2,3, Naim Issa4,5, Ann-Claire Gourinat6, Magali Savalle7, Elodie Chalus8, Jerome Laurence9,10,11, Steven Chadban12,13, Kate Wyburn12,13. 1. Division of Nephrology, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland. 2. Division of Transplantation, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland. 3. RESIR, Réseau de l'Insuffisance Rénale en Nouvelle Calédonie, Nouméa, New Caledonia. 4. Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA. 5. William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA. 6. Microbiology Laboratory, Centre Hospitalier Territorial Gaston-Bourret, Dumbéa, New Caledonia. 7. Intensive Care Unit, Centre Hospitalier Territorial Gaston-Bourret, Dumbéa, New Caledonia. 8. Department of Blood Transfusion, Centre Hospitalier Territorial Gaston-Bourret, Dumbéa, New Caledonia. 9. Central Clinical School, University of Sydney, NSW, Australia. 10. Department of Surgery, Westmead Hospital, University of Sydney, NSW, Australia. 11. Royal Prince Alfred Hospital, Institute of Academic Surgery, University of Sydney, NSW, Australia. 12. Department of Renal Medicine, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia. 13. Charles Perkins Centre Kidney Node, The University of Sydney, Sydney, NSW, Australia.
To the EditorWith 270,000 inhabitants, New Caledonia has a very high prevalence of end-stage kidney disease, with the fourth highest globally. New Caledonia started a deceased- and live-donor kidney transplantation program 5 years ago.1, 2 After the first positive cases of COVID-19 were diagnosed on March 18, 2020, the New Caledonian government halted all flights. It mandated a strict 14-day quarantine period for all returning visitors and residents in a government-designated hotel. All COVID-19–positive individuals were hospitalized, even if they were asymptomatic. An extensive screening program was implemented with an average COVID-19 reverse transcriptase polymerase chain reaction test of 14,800 per million. Among 19,544 tests, only 40 cases were positive (35 imported and 5 secondary cases). Data showed that COVID-19 did not circulate among the population. Only a small number of imported cases were diagnosed in the context of a comprehensive screening policy and strict isolation rules, with no new cases detected since March 31, 2020. This government policy was very effective in protecting the country from the direct consequences of COVID-19, but it dramatically impacted kidney transplantation. Because of border closures, no patient could be transplanted through the Australian and New Zealand Paired Kidney Exchange program. Only 11 kidney transplants were performed in 2020 compared with an average of 23 transplants for the 4 preceding years, representing a nearly 50% drop in transplant activities (Figure 1, Supplementary Table S1).
Figure 1
Evolution of the number of kidney transplants (TX) of New Caledonia patients by donor type and location of the transplant surgery. DD, kidney transplantation from a deceased donor; LD, kidney transplantation from a living donor.
Evolution of the number of kidney transplants (TX) of New Caledonia patients by donor type and location of the transplant surgery. DD, kidney transplantation from a deceased donor; LD, kidney transplantation from a living donor.The indirect impact of the pandemic was even more than reported for countries with authenticated epidemics., Multiple factors explain this New Caledonian COVID-19 paradox. First, halting elective surgeries was deleterious on the newly established living-donor transplant program established less than 1 year prior in almost complete autonomy. Second, the reduced mobility of surgeons from expert centers in France and Australia was also an essential factor. Finally, patients could not travel to France or Australia for the more complex living-donor transplants that could not be performed locally in New Caledonia. This COVID-19 collateral effect on kidney transplantation was much more deleterious than the direct effect of the COVID-19 epidemic itself. The 2020 COVID-19 pandemic protective closure measures nipped this country’s local kidney transplant program in the bud.
Authors: Steven J Chadban; Mark McDonald; Kate Wyburn; Helen Opdam; Lucinda Barry; P Toby Coates Journal: Kidney Int Date: 2020-10-21 Impact factor: 10.612
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