TY - JOUR
T1 - Early national and center-level changes to kidney transplantation in the United States during the COVID-19 epidemic
AU - Boyarsky, Brian J.
AU - Werbel, William A.
AU - Durand, Christine M.
AU - Avery, Robin K.
AU - Jackson, Kyle R.
AU - Kernodle, Amber B.
AU - Snyder, Jon
AU - Hirose, Ryutaro
AU - Massie, Indraneel M.
AU - Garonzik-Wang, Jacqueline M.
AU - Segev, Dorry L.
AU - Massie, Allan B.
N1 - Funding Information:
This research was made possible with generous support of the Ben‐Dov family. This work was supported by grant numbers T32DK007713 (Boyarsky), F32DK113719 (Jackson), F32DK117563 (Kernodle), K24DK101828 (Segev), and K01DK101677 (Massie) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and T32AI007291 (Werbel) from the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health. The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the US Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the US Government. The data reported here have been supplied by the Hennepin Healthcare Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government.
Funding Information:
This research was made possible with generous support of the Ben-Dov family. This work was supported by grant numbers T32DK007713 (Boyarsky), F32DK113719 (Jackson), F32DK117563 (Kernodle), K24DK101828 (Segev), and K01DK101677 (Massie) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and T32AI007291 (Werbel) from the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health. The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the US Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the US Government. The data reported here have been supplied by the Hennepin Healthcare Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government.
Publisher Copyright:
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2020/11/1
Y1 - 2020/11/1
N2 - 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.
AB - 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.
KW - clinical research/practice
KW - donors and donation: deceased
KW - donors and donation: living
KW - health services and outcomes research
KW - infection and infectious agents – viral
KW - infectious disease
KW - kidney transplantation/nephrology
KW - organ transplantation in general
KW - patient survival
KW - registry/registry analysis
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U2 - 10.1111/ajt.16167
DO - 10.1111/ajt.16167
M3 - Article
C2 - 32594606
AN - SCOPUS:85088976117
SN - 1600-6135
VL - 20
SP - 3131
EP - 3139
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 11
ER -