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

• Type of Material: Article
• Authors: Brian J Boyarsky, Johns Hopkins University; William A Werbel, Johns Hopkins University; Christine M Durand, Johns Hopkins University; Robin K Avery, Johns Hopkins University; Kyle Jackson, Emory University; Amber B Kernodle, Johns Hopkins University; Jon Snyder, Scientific Registry of Transplant Recipients; Ryutaro Hirose, University of California San Francisco; Indraneel M Massie, Emory University; Jacqueline M Garonzik-Wang, Johns Hopkins University; Dorry L Segev, Johns Hopkins University; Allan B Massie, Johns Hopkins University
• Language: English
• Date: 2020-08-05
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2020 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1111/ajt.16167
• Title of Journal or Parent Work: AMERICAN JOURNAL OF TRANSPLANTATION
• Volume: 20
• Issue: 11
• Start Page: 3131
• End Page: 3139
• Grant/Funding Information: National Institute of Diabetes and Digestive and Kidney Diseases, Grant/Award Number: F32DK117563, F32DK113719, K01DK101677, K24DK101828 and T32DK007713; National Institute of Allergy and Infectious Diseases, Grant/Award Number: T32AI007291
• Keywords: Science & Technology; practice; living; Life Sciences & Biomedicine; organ transplantation in general; nephrology; deceased; Transplantation; infectious disease; health services and outcomes research; registry; patient survival; donors and donation; Surgery; infection and infectious agents - viral; kidney transplantation; registry analysis; clinical research

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.