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. 2020 Jul;20(7):1809-1818.
doi: 10.1111/ajt.15915. Epub 2020 May 10.

Early impact of COVID-19 on transplant center practices and policies in the United States

Brian J Boyarsky  1 , Teresa Po-Yu Chiang  1 , William A Werbel  2 , Christine M Durand  2 , Robin K Avery  2 , Samantha N Getsin  1 , Kyle R Jackson  1 , Amber B Kernodle  1 , Sarah E Van Pilsum Rasmussen  2 , Allan B Massie  1   3 , Dorry L Segev  1   3 , Jacqueline M Garonzik-Wang  1
Affiliations

Early impact of COVID-19 on transplant center practices and policies in the United States

Brian J Boyarsky et al. Am J Transplant. 2020 Jul.

Abstract

COVID-19 is a novel, rapidly changing pandemic: consequently, evidence-based recommendations in solid organ transplantation (SOT) remain challenging and unclear. To understand the impact on transplant activity across the United States, and center-level variation in testing, clinical practice, and policies, we conducted a national survey between March 24, 2020 and March 31, 2020 and linked responses to the COVID-19 incidence map. Response rate was a very high 79.3%, reflecting a strong national priority to better understand COVID-19. Complete suspension of live donor kidney transplantation was reported by 71.8% and live donor liver by 67.7%. While complete suspension of deceased donor transplantation was less frequent, some restrictions to deceased donor kidney transplantation were reported by 84.0% and deceased donor liver by 73.3%; more stringent restrictions were associated with higher regional incidence of COVID-19. Shortage of COVID-19 tests was reported by 42.5%. Respondents reported a total of 148 COVID-19 recipients from <1 to >10 years posttransplant: 69.6% were kidney recipients, and 25.0% were critically ill. Hydroxychloroquine (HCQ) was used by 78.1% of respondents; azithromycin by 46.9%; tocilizumab by 31.3%, and remdesivir by 25.0%. There is wide heterogeneity in center-level response across the United States; ongoing national data collection, expert discussion, and clinical studies are critical to informing evidence-based practices.

Keywords: clinical decision-making; epidemiology; guidelines; infectious agents-viral.

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Figures

FIGURE 1
FIGURE 1
A, Transplant center SOT activity by state-level cumulative incidence of COVID-19. B, Perceptions of SOT activity that should continue by organ and state-level cumulative incidence of COVID-19. Cumulative incidence PMP on March 24, 2020 [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Distribution of respondent concern by state-level cumulative incidence. Cumulative incidence PMP on March 24, 2020
FIGURE 3
FIGURE 3
Respondent perception of anticipated and current shortages of supplies by state-level cumulative incidence. Cumulative incidence PMP on March 24, 2020 [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 4
FIGURE 4
Respondent-reported COVID-19 cases by state-level cumulative incidence. Cumulative incidence PMP on March 24, 2020 [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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