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. 2021 Jun;21(6):2262-2268.
doi: 10.1111/ajt.16550. Epub 2021 Mar 6.

Mortality among solid organ waitlist candidates during COVID-19 in the United States

Jonathan Miller  1 , Andrew Wey  1 , Donald Musgrove  1 , Yoon Son Ahn  1 , Allyson Hart  1   2 , Bertram L Kasiske  1   2 , Ryutaro Hirose  3 , Ajay K Israni  1   2   4 , Jon J Snyder  1   4
Affiliations

Mortality among solid organ waitlist candidates during COVID-19 in the United States

Jonathan Miller et al. Am J Transplant. 2021 Jun.

Abstract

We examined the effects of COVID-19 on solid organ waiting list mortality in the United States and compared effects across patient demographics (e.g., race, age, and sex) and donation service areas. Three separate piecewise exponential survival models estimated for each solid organ the overall, demographic-specific, and donation service area-specific differences in the hazard of waitlist mortality before and after the national emergency declaration on March 13, 2020. Kidney waiting list mortality was higher after than before the national emergency (adjusted hazard ratio [aHR], 1.37; 95% CI, 1.23-1.52). The hazard of waitlist mortality was not significantly different before and after COVID-19 for liver (aHR, 0.94), pancreas (aHR, 1.01), lung (aHR, 1.00), and heart (aHR, 0.94). Kidney candidates had notable variability in differences across donation service areas (aHRs, New York City, 2.52; New Jersey, 1.84; and Michigan, 1.56). The only demographic group with increased waiting list mortality were Blacks versus Whites (aHR, 1.41; 95% CI, 1.07-1.86) for kidney candidates. The first 10 weeks after the declaration of a national emergency had a heterogeneous effect on waitlist mortality rate, varying by geography and ethnicity. This heterogeneity will complicate comparisons of transplant program performance during COVID-19.

Keywords: health services and outcomes research; heart transplantation/cardiology; kidney transplantation/nephrology; kidney transplantation: living donor; liver transplantation/hepatology; lung transplantation: living donor; patient survival; waitlist management.

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Figures

FIGURE 1
FIGURE 1
Impact of COVID-19 on mortality hazard among organ waitlist candidates
FIGURE 2
FIGURE 2
Time trends in waitlist mortality hazard among organ waitlist candidates
FIGURE 3
FIGURE 3
Geographic variation in waitlist mortality hazard for kidney transplant across the United States after COVID-19 compared to before [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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