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Comparative Study
. 2020 Nov;20(11):3131-3139.
doi: 10.1111/ajt.16167. Epub 2020 Aug 5.

Early national and center-level changes to kidney transplantation in the United States during the COVID-19 epidemic

Brian J Boyarsky  1 , William A Werbel  2 , Christine M Durand  2 , Robin K Avery  2 , Kyle R Jackson  1 , Amber B Kernodle  1 , Jon Snyder  3 , Ryutaro Hirose  4 , Indraneel M Massie  5 , Jacqueline M Garonzik-Wang  1 , Dorry L Segev  1   6   3 , Allan B Massie  1   2
Affiliations
Comparative Study

Early national and center-level changes to kidney transplantation in the United States during the COVID-19 epidemic

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

Abstract

In March 2020, coronavirus disease 2019 (COVID-19) spread rapidly nationally, causing widespread emergent changes to the health system. Our goal was to understand the impact of the epidemic on kidney transplantation (KT), at both the national and center levels, accounting statistically for waitlist composition. Using Scientific Registry of Transplant Recipients data, we compared data on observed waitlist registrations, waitlist mortality, and living-donor and deceased-donor kidney transplants (LDKT/DDKT) March 15-April 30, 2020 to expected events calculated from preepidemic data January 2016-February 2020. There were few changes before March 15, at which point the number of new listings/DDKT/LDKT dropped to 18%/24%/87% below the expected value (all P < .001). Only 12 centers performed LDKT March 15-31; by April 30, 40 centers had resumed LDKT. The decline in new listings and DDKT was greater among states with higher per capita confirmed COVID-19 cases. The number of waitlist deaths was 2.2-fold higher than expected in the 5 states with highest COVID-19 burden (P < .001). DCD DDKT and regional/national imports declined nationwide but most steeply in states with the highest COVID-19 burden. The COVID-19 epidemic has resulted in substantial changes to KT; we must adapt and learn rapidly to continue to provide safe access to transplantation and limit the growing indirect toll of an already deadly disease.

Keywords: clinical research/practice; donors and donation: deceased; donors and donation: living; health services and outcomes research; infection and infectious agents - viral; infectious disease; kidney transplantation/nephrology; organ transplantation in general; patient survival; registry/registry analysis.

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Figures

FIGURE 1
FIGURE 1
Kidney transplant (KT) waitlist registrations and active status, February-April 2020. Counts of new deceased-donor kidney transplantation (DDKT) waitlist registrations (A) and patients moved to inactive status (B) per day, with Lowess smooth; (C) proportion of prevalent waitlist list listed as inactive per day [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Counts of kidney transplant (KT) waitlist outcomes per day, February-April 2020, with Lowess smooth: (A) removals due to death; (B) removals due to deteriorating condition [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Counts of deceased-donor kidney transplantation (DDKT) per day, February-April 2020, with Lowess smooth: (A) all DDKT, (B) donation after cardiac death (DCD), (C) regional imports, (D) national imports [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 4
FIGURE 4
Living-donor kidney transplantation (LDKT), February-April 2020. (A) Counts of LDKT per day, February-March 2020, with Lowess smooth. (B) Center-level LDKT, February-April 2020, by coronavirus disease 2019 (COVID-19) prevalence per million population. Centers from states where more than 1 LDKT was performed are marked in dark red [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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