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

Brian J. Boyarsky, William A. Werbel, Christine M. Durand, Robin K. Avery, Kyle R. Jackson, Amber B. Kernodle, Jon Snyder, Ryutaro Hirose, Indraneel M. Massie, Jacqueline M. Garonzik-Wang, Dorry L. Segev, Allan B. Massie

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)3131-3139
Number of pages9
JournalAmerican Journal of Transplantation
Issue number11
StatePublished - Nov 1 2020


  • 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

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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