OPTN/SRTR 2021 Annual Data Report: COVID-19

Abstract

This chapter updates the COVID-19 chapter from the 2020 Annual Data Report with trends through February 12, 2022, and introduces trends in COVID-19-specific cause of death on the waiting list and posttransplant. Transplant rates remain at or above prepandemic levels for all organs, indicating a sustained transplantation system recovery following the initial 3-month disruption due to the onset of the pandemic. Posttransplant mortality and graft failure remain a concern in all organs, with rates surging corresponding to waves of the pandemic. Waitlist mortality due to COVID-19 is also a concern, particularly among kidney candidates. While the recovery of the transplantation system has been sustained in the second year of the pandemic, ongoing efforts should focus on reducing posttransplant and waitlist mortality due to COVID-19, and graft failure.

Keywords: COVID-19; solid organ transplant; transplant outcomes; waitlist mortality.

Figure COV 1

Number of prevalent kidney candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the month.

Figure COV 2

Number of new kidney candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. A new candidate is one who first joined the list during the given month, without having been listed in a previous month.

Figure COV 3

Deceased donor kidney transplant rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given month. Individual listings are counted separately.

Figure COV 4

Living donor kidney transplant rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of living donor transplants per 100 patient-years of waiting in a given month. Individual listings are counted separately.

Figure COV 5

Number of kidney offers. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 6

Kidney offer acceptance rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 7

Kidney waitlist mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 8

Kidney waitlist COVID-19 mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 9

Kidney all-cause graft failure. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 10

Kidney post-transplant COVID-19 mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 11

Difference in risk adjusted kidney waitlist mortality hazard ratio before to after COVID-19 by OPO. Waitlist mortality hazard ratio is the difference in the organ procurement organization’s (OPO’s) hazard ratio compared to the nation as a whole in the 12 months after the onset of the COVID-19 pandemic as compared to the 12 months before the onset of the pandemic. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Model adjusted for blood type, age in years, body mass index, calculated panel reactive antibody, primary diagnosis, duration of dialysis, miles between candidate and program, ethnicity, sex, type of kidney transplant, candidate insurance type, race, previous transplant for candidates, candidate urbanicity, and waiting time (years).

Figure COV 12

Difference in risk adjusted kidney transplant rate before to after COVID-19 by OPO. Transplant rate ratio is the difference in the organ procurement organization’s (OPO’s) rate ratio compared to the nation as a whole in the 12 months after the onset of the COVID-19 pandemic as compared to the 12 months before the onset of the pandemic. Individual listings are counted separately. Model adjusted for blood type, age in years, body mass index, calculated panel reactive antibody, primary diagnosis, duration of dialysis, miles between candidate and program, ethnicity, sex, type of kidney transplant, candidate insurance type, race, previous transplant for candidates, candidate urbanicity, and waiting time (years).

Figure COV 13

Difference in risk adjusted kidney all-cause graft failure hazard ratio before to after COVID-19 by OPO. Graft failure hazard ratio is the difference in the organ procurement organization’s (OPO’s) hazard ratio compared to the nation as a whole in the 12 months after the onset of the COVID-19 pandemic as compared to the 12 months before the onset of the pandemic. Model adjusted for blood type, ethnicity, sex, candidate insurance type, race, donor age (years), donor ethnicity, donor hypertension status, donor race, donor sex, recipient age (years), body mass index, cold ischemia time (hours), primary diagnosis, diabetes status, years of dialysis, miles between recipient and program, donor diabetes status, donor serum creatinine, donor type, number of HLA mismatches, donor kidney donor profile index, multiorgan transplant, calculated panel reactive antibody, recipient had a previous transplant, recipient urbanicity, type of kidney transplant, and miles between donor and program.

Figure COV 14

Number of prevalent pancreas candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the month.

Figure COV 15

Number of new pancreas candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. A new candidate is one who first joined the list during the given month, without having been listed in a previous month.

Figure COV 16

Deceased donor pancreas transplant rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given month. Individual listings are counted separately.

Figure COV 17

Pancreas waitlist mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 18

Pancreas all-cause graft failure. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 19

Pancreas post-transplant COVID-19 mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 20

Difference in risk adjusted pancreas waitlist mortality hazard ratio before to after COVID-19 by OPO. Waitlist mortality hazard ratio is the difference in the organ procurement organization (OPO’s) hazard ratio compared to the nation as a whole in the 12 months after the onset of the COVID-19 pandemic as compared to the 12 months before the onset of the pandemic. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Model adjusted for blood type, age in years, body mass index, primary diagnosis, duration of dialysis, miles between candidate and program, ethnicity, sex, type of pancreas transplant, candidate insurance type, race, previous transplant for candidates, candidate urbanicity, and waiting time.

Figure COV 21

Difference in risk adjusted pancreas transplant rate before to after COVID-19 by OPO. Transplant rate ratio is the difference in the organ procurement organization’s (OPO’s) rate ratio compared to the nation as a whole in the 12 months after the onset of the COVID-19 pandemic as compared to the 12 months before the onset of the pandemic. Individual listings are counted separately. Model adjusted for blood type, age in years, body mass index, primary diagnosis, duration of dialysis, miles between candidate and program, ethnicity, sex, type of pancreas transplant, candidate insurance type, race, previous transplant for candidates, candidate urbanicity, and waiting time.

Figure COV 22

Difference in risk adjusted pancreas all-cause graft failure hazard ratio before to after COVID-19 by OPO. Graft failure hazard ratio is the difference in the organ procurement organization’s (OPO’s) hazard ratio compared to the nation as a whole in the 12 months after the onset of the COVID-19 pandemic as compared to the 12 months before the onset of the pandemic. Model adjusted for blood type, ethnicity, sex, candidate insurance type, race, donor age (years), donor ethnicity, donor hypertension status, donor race, donor sex, recipient age (years), body mass index, primary diagnosis, years of dialysis, miles between recipient and program, donor type, recipient urbanicity, and miles between donor and program.

Figure COV 23

Number of prevalent liver candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the month.

Figure COV 24

Number of new liver candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. A new candidate is one who first joined the list during the given month, without having been listed in a previous month.

Figure COV 25

Deceased donor liver transplant rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given month. Individual listings are counted separately.

Figure COV 26

Living donor liver transplant rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of living donor transplants per 100 patient-years of waiting in a given month. Individual listings are counted separately.

Figure COV 27

Number of liver offers. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 28

Liver offer acceptance rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 29

Liver waitlist mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 30

Liver waitlist COVID-19 mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 31

Liver all-cause graft failure. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 32

Liver post-transplant COVID-19 mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 33

Difference in risk adjusted liver waitlist mortality hazard ratio before to after COVID-19 by OPO. Waitlist mortality hazard ratio is the difference in the organ procurement organization’s (OPO’s) hazard ratio compared to the nation as a whole in the 12 months after the onset of the COVID-19 pandemic as compared to the 12 months before the onset of the pandemic. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Model adjusted for blood type, age in years, body mass index, primary diagnosis, miles between candidate and program, ethnicity, pediatric end-stage liver disease (PELD)/model for end-stage liver disease (MELD) score, sex, hepatocellular carcinoma status, candidate insurance type, race, previous transplant for candidates, candidate urbanicity, and waiting time.

Figure COV 34

Difference in risk adjusted liver transplant rate before to after COVID-19 by OPO. Transplant rate ratio is the difference in the organ procurement organization’s (OPO’s) rate ratio compared to the nation as a whole in the 12 months after the onset of the COVID-19 pandemic as compared to the 12 months before the onset of the pandemic. Individual listings are counted separately. Model adjusted for blood type, age in years, body mass index, primary diagnosis, miles between candidate and program, ethnicity, pediatric end-stage liver disease (PELD)/model for end-stage liver disease (MELD) score, sex, hepatocellular carcinoma status, candidate insurance type, race, previous transplant for candidates, candidate urbanicity, and waiting time.

Figure COV 35

Difference in risk adjusted liver all-cause graft failure hazard ratio before to after COVID-19 by OPO. Graft failure hazard ratio is the difference in the organ procurement organization’s (OPO’s) hazard ratio compared to the nation as a whole in the 12 months after the onset of the COVID-19 pandemic as compared to the 12 months before the onset of the pandemic. Model adjusted for blood type, ethnicity, sex, candidate insurance type, race, donor age (years), donor ethnicity, donor hypertension status, donor race, donor sex, recipient age (years), body mass index, cold ischemia time (hours), primary diagnosis, miles between recipient and program, donor diabetes status, donor type, recipient hepatocellular carcinoma status, number of HLA mismatches, laboratory model for end-stage liver disease (MELD) at transplant, multiorgan transplant, recipient had a previous transplant, recipient urbanicity, miles between donor and program, and type of liver transplant.

Figure COV 36

Number of prevalent intestine candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the month.

Figure COV 37

Number of new intestine candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. A new candidate is one who first joined the list during the given month, without having been listed in a previous month.

Figure COV 38

Deceased donor intestine transplant rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given month. Individual listings are counted separately.

Figure COV 39

Intestine waitlist mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 40

Intestine all-cause graft failure. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 41

Difference in risk adjusted intestine transplant rate before to after COVID-19 by OPO. Transplant rate ratio is the difference in the organ procurement organization’s (OPO’s) rate ratio compared to the nation as a whole in the 12 months after the onset of the COVID-19 pandemic as compared to the 12 months before the onset of the pandemic. Individual listings are counted separately. Model adjusted for blood type, age in years, body mass index, primary diagnosis, miles between candidate and program, ethnicity, sex, intestine listing type, candidate insurance type, race, previous transplant for candidates, candidate urbanicity, and waiting time.

Figure COV 42

Difference in risk adjusted intestine all-cause graft failure hazard ratio before to after COVID-19 by OPO. Graft failure hazard ratio is the difference in the organ procurement organization’s (OPO’s) hazard ratio compared to the nation as a whole in the 12 months after the onset of the COVID-19 pandemic as compared to the 12 months before the onset of the pandemic. Model adjusted for ethnicity, sex, candidate insurance type, race, donor age (years), donor diabetes status, donor hypertension status, recipient age (years), body mass index, primary diagnosis, miles between recipient and program, intestine transplant type, recipient had a previous transplant, recipient urbanicity, and miles between donor and program.

Figure COV 43

Number of prevalent heart candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the month.

Figure COV 44

Number of new heart candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. A new candidate is one who first joined the list during the given month, without having been listed in a previous month.

Figure COV 45

Deceased donor heart transplant rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given month. Individual listings are counted separately.

Figure COV 46

Number of heart offers. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 47

Heart offer acceptance rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 48

Heart waitlist mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 49

Heart waitlist COVID-19 mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 50

Heart all-cause graft failure. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 51

Heart post-transplant COVID-19 mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 52

Difference in risk adjusted heart waitlist mortality hazard ratio before to after COVID-19 by OPO. Waitlist mortality hazard ratio is the difference in the organ procurement organization’s (OPO’s) hazard ratio compared to the nation as a whole in the 12 months after the onset of the COVID-19 pandemic as compared to the 12 months before the onset of the pandemic. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Model adjusted for blood type, age in years, body mass index, primary diagnosis, miles between candidate and program, ethnicity, sex, height at listing (cm), candidate insurance type, race, previous transplant for candidates, candidate urbanicity, ventricular assist device status at listing, and waiting time.

Figure COV 53

Difference in risk adjusted heart transplant rate before to after COVID-19 by OPO. Transplant rate ratio is the difference in the organ procurement organization’s (OPO’s) rate ratio compared to the nation as a whole in the 12 months after the onset of the COVID-19 pandemic as compared to the 12 months before the onset of the pandemic. Individual listings are counted separately. Model adjusted for blood type, age in years, body mass index, primary diagnosis, miles between candidate and program, ethnicity, sex, height at listing (cm), candidate insurance type, race, previous transplant for candidates, candidate urbanicity, ventricular assist device status at listing, and waiting time.

Figure COV 54

Difference in risk adjusted heart all-cause graft failure hazard ratio before to after COVID-19 by OPO. Graft failure hazard ratio is the difference in the organ procurement organization’s (OPO’s) hazard ratio compared to the nation as a whole in the 12 months after the onset of the COVID-19 pandemic as compared to the 12 months before the onset of the pandemic. Model adjusted for blood type, ethnicity, sex, candidate insurance type, race, donor age (years), donor diabetes status, donor ethnicity, donor hypertension status, donor race, donor sex, recipient age (years), body mass index, primary diagnosis, miles between recipient and program, number of HLA mismatches, allocation tier, height at transplant (cm), multiorgan transplant, recipient had a previous transplant, recipient urbanicity, ventricular assist device at transplant, and miles between donor and program.

Figure COV 55

Number of prevalent lung candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the month.

Figure COV 56

Number of new lung candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. A new candidate is one who first joined the list during the given month, without having been listed in a previous month.

Figure COV 57

Deceased donor lung transplant rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given month. Individual listings are counted separately.

Figure COV 58

Number of lung offers. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 59

Lung offer acceptance rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 60

Lung waitlist mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 61

Lung waitlist COVID-19 mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 62

Lung all-cause graft failure. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 63

Lung post-transplant COVID-19 mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 64

Difference in risk adjusted lung waitlist mortality hazard ratio before to after COVID-19 by OPO. Waitlist mortality hazard ratio is the difference in the organ procurement organization’s (OPO’s) hazard ratio compared to the nation as a whole in the 12 months after the onset of the COVID-19 pandemic as compared to the 12 months before the onset of the pandemic. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Model adjusted for blood type, age in years, body mass index, diagnosis group, pediatric diagnosis group, miles between candidate and program, ethnicity, sex, height at listing (cm), lung allocation score category, candidate insurance type, race, previous transplant for candidates, candidate urbanicity, and waiting time.

Figure COV 65

Difference in risk adjusted lung transplant rate before to after COVID-19 by OPO. Transplant rate ratio is the difference in the organ procurement organization’s (OPO’s) rate ratio compared to the nation as a whole in the 12 months after the onset of the COVID-19 pandemic as compared to the 12 months before the onset of the pandemic. Individual listings are counted separately. Model adjusted for blood type, age in years, body mass index, diagnosis group, pediatric diagnosis group, miles between candidate and program, ethnicity, sex, height at listing (cm), lung allocation score category, candidate insurance type, race, previous transplant for candidates, candidate urbanicity, and waiting time.

Figure COV 66

Difference in risk adjusted lung all-cause graft failure hazard ratio before to after COVID-19 by OPO. Graft failure hazard ratio is the difference in the organ procurement organization’s (OPO’s) hazard ratio compared to the nation as a whole in the 12 months after the onset of the COVID-19 pandemic as compared to the 12 months before the onset of the pandemic. Model adjusted for blood type, ethnicity, sex, candidate insurance type, race, donor age (years), donor diabetes status, donor ethnicity, donor hypertension status, donor race, donor sex, donor smoked more than 20 packs per year, recipient age (years), body mass index, diagnosis group, miles between recipient and program, donor type, number of HLA mismatches, height at transplant (cm), lung allocation score at transplant, multiorgan transplant, recipient had a previous transplant, recipient urbanicity, and miles between donor and program.