ABSTRACT
Purpose: During the COVID-19 pandemic, many transplant centers modified induction immunosuppression regimens. Beginning December 2020, our center reduced anti-thymocyte globulin (ATG) protocol dosing by up to 33% compared to the pre-pandemic doses (7.5, 4.5, and 3mg/kg, per immunologic risk) for all recipients, with no change in maintenance immunosuppression. We examined the impact of reduced ATG dose on kidney allograft and transplant recipient outcomes. Method(s): We retrospectively reviewed adult recipients who received a kidney transplant between December 2020 and March 2021 (pandemic) with a minimum of 6 months follow up post-transplant, and recipients who received a transplant between January 2019 and December 2019 (pre-pandemic). We chose 2019 as a comparable pre-pandemic cohort as they were treated without influence from the COVID-19 pandemic. We ed patient demographic and laboratory data from electronic health records. We excluded multi-organ transplant recipients. Result(s): 78 adult kidney transplants were performed during the pandemic era and 211 were performed during the pre-pandemic era. The characteristics of the two cohorts are illustrated in Table 1. The primary outcomes are illustrated in Figure 1. The rate of biopsy proven rejection (including surveillance and for-cause biopsies) did not increase during the pandemic as compared to pre-pandemic era (6.3% vs 8.0%, respectively, p=0.8). The rate of BK viremia (>1000 copies/mL) at 3 months was lower in the pandemic era, but not statistically significant (6.4% vs 8.7%, respectively, p=0.6). The rate of delayed graft function (DGF) was significantly higher in the pandemic era compared to pre-pandemic (42.3% vs 22.9%, respectively, p=0.002). No recipients tested positive for COVID-19 within 1-month of transplant. Conclusion(s): Despite the reduction in ATG dose, we found no significant change in the rate of rejection or infection. We did however find a significant increase in the rate of DGF during the pandemic era. Further studies are needed to assess the long-term effects of reduced induction immunosuppression regimen on kidney transplant recipients. (Figure Presented).
ABSTRACT
What kind of leadership role is China playing in the G20? How has this leadership role evolved over time, particularly with the recent global crises created by the COVID-19 pandemic? In addition, will China’s rising role in providing badly needed global public goods reinforce its rivalry with a declining US, present the opportunity of co-leading with its BRICS counterparts, or mediate and foster co-operative solutions among all? This study seeks to address these critical questions using quantitative analysis based on G20 compliance data since its start in 2008, and especially at the recent Osaka Summit in June 2019 and the emergency virtual summit on March 26, 2020. Specifically, this study analyses China’s changing compliance levels over time and across issue areas, in comparison with its key G20 partners (or rivals): the US, India and Russia. Observing China’s compliance trends alongside those of other major G20 powers provides important insights into the characteristics, evolution and interactions of China’s leadership. This analysis finds that China’s leadership role has increased over time but that China remains largely a flexible and co-operative leader. From 2008 to 2018, China’s compliance rose while that of the US declined. Overall, China leads more with its BRICS partners than with the US. China’s leadership model has been characterized by flexibility and cooperativeness, as China has never led alone, and China’s closest compliance companions vary across different issue areas. China and other G20 members’ compliance in 2020 largely confirms these trends and the causal strength of the shock activated vulnerability of COVID-19 and members’ relevant specialized capabilities in response. © 2021, Fudan University.