COVID-19–related collapse of transplantation systems: A heterogeneous recovery?

Rodrigo, Emilio; Miñambres, Eduardo; Gutiérrez-Baños, J.L.; Valero, Rosalía; Belmar, Lara; Ruiz, J.C.

doi:10.1111/ajt.16125

Cited by 16 publications

(13 citation statements)

References 5 publications

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“…During the pandemic, transplantation volume in the United States in March, April, and May of 2020 was severely curtailed, with an overall reduction in deceased donor transplantation of 51% 1 . This effect was largely driven by kidney transplantation, and was echoed in other countries, including France and Spain where transplantation fell 90% and 87%, respectively 1,2 . This severe decline in transplantation activity was borne, in part, out of concerns over potentially increased susceptibility and worsened outcomes of COVID‐19 in transplant recipients, as well as concerns over impaired hospital resources for caring for posttransplant recipients.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 outcomes in patients waitlisted for kidney transplantation and kidney transplant recipients

Craig‐Schapiro

Salinas

Lubetzky

et al. 2021

American Journal of Transplantation

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The COVID‐19 pandemic has brought unprecedented challenges to the transplant community. The reduction in transplantation volume during this time is partly due to concerns over potentially increased susceptibility and worsened outcomes of COVID‐19 in immunosuppressed recipients. The consequences of COVID‐19 on patients waitlisted for kidney transplantation, however, have not previously been characterized. We studied 56 waitlisted patients and 80 kidney transplant recipients diagnosed with COVID‐19 between March 13 and May 20, 2020. Despite similar demographics and burden of comorbidities between waitlisted and transplant patients, waitlisted patients were more likely to require hospitalization (82% vs. 65%, P = .03) and were at a higher risk of mortality (34% vs. 16%, P = .02). Intubation was required in one third of hospitalized patients in each group, and portended a very poor prognosis. The vast majority of patients who died were male (84% waitlist, 100% transplant). Multivariate analysis demonstrated waitlist status, age, and male sex were independently associated with mortality. COVID‐19 has had a dramatic impact on waitlisted patients, decreasing their opportunities for transplantation and posing significant mortality risk. Understanding the impact of COVID‐19 on waitlist patients in comparison to transplant recipients may aid centers in weighing the risks and benefits of transplantation in the setting of ongoing COVID‐19.

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Section: Introductionmentioning

confidence: 99%

COVID-19 outcomes in patients waitlisted for kidney transplantation and kidney transplant recipients

Craig‐Schapiro

Salinas

Lubetzky

et al. 2021

American Journal of Transplantation

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“…The COVID-19 pandemic has had a dramatic impact on organ transplantation in the United States and globally, with a particularly large effect on kidney transplantation. [1][2][3] A substantial reduction in transplant activity…”

Section: Introductionmentioning

confidence: 99%

COVID-19–Associated Mortality among Kidney Transplant Recipients and Candidates in the United States

Mohan

King

Husain

et al. 2021

CJASN

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Background and Objectives: The COVID-19 pandemic has had a profound impact on transplantation activity in the United States and globally. Several single center reports suggest higher morbidity and mortality among candidates waitlisted for a kidney transplant as well as recipients of a kidney transplant. We aim to describe 2020 mortality patterns during the COVID-19 pandemic in the United States among kidney transplant candidates and recipients. Design, Setting, Participants, and Measurements: Using national registry data for waitlisted candidates and kidney transplant recipients collected through April 23, 2021, we report demographic and clinical factors associated with COVID-19 related mortality in 2020, other deaths in 2020 and deaths in 2019 among waitlisted candidates and transplant recipients . We quantify excess all-cause deaths among candidate and recipient populations in 2020 as well as deaths directly attributed to COVID-19 in relation to pre-pandemic mortality patterns in 2019 and 2018. Results: Among waitlisted patient deaths in 2020, 11% of deaths were attributed to COVID-19, and these candidates were more likely to be male, obese, and belong to a racial/ethnic minority group. Nearly 1 in 6 deaths (16%) among active transplant recipients in the United States in 2020 was attributed to COVID-19. Recipients who died of COVID-19 were younger, more likely to be obese, had lower educational attainment, and were more likely to belong to racial/ethnic minority groups than those who died of other causes in 2020 or 2019. We found higher overall mortality in 2020 among waitlisted candidates (24%) than among kidney transplant recipients (20%) compared to 2019. Conclusions: Our analysis demonstrates higher rates of mortality associated with COVID-19 among waitlisted candidates and kidney transplant recipients in the United States in 2020.

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“…Guidance from professional societies would aid transplant programs in developing their customised clinical pathway. National organ allocation network could identify centres with low loco-regional prevalence of COVID-19 that can resume transplant activities much faster in order to maximise organ utilisation[ 13 ]. Organisations, commissioners, and networks working on developing the clinical pathways should keep in mind that there will be ongoing long-term effects from this pandemic like lengthy waiting lists, resultant increased mortality in the waiting list, and adverse pre-transplant conditions.…”

Section: Development Of Clinical Pathwaysmentioning

confidence: 99%

COVID-19 pandemic: Building organisational flexibility to scale transplant programs

Gopal

Papalois

2020

WJT

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The prevailing coronavirus disease 2019 pandemic has challenged our lives in an unprecedented manner. The pandemic has had a significant impact on transplantation worldwide. The logistics of travel restrictions, stretching of available resources, unclear risk of infection in immunosuppressed transplant recipients, and evolving guidelines on testing and transplantation are some of the factors that have unfavourably influenced transplant activity. We must begin to build organisational flexibility in order to restart transplantation so that we can be mindful stewards of organ donation and sincere advocates for our patients. Building a culture of honesty and transparency (with patients, families, colleagues, societies, and authorities), keeping the channels of communication open, working in collaboration with others (at local, regional, national, and international levels), and not restarting without rethinking and appraising all elements of our practice, are the main underlying principles to increase the flexibility.

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COVID-19–related collapse of transplantation systems: A heterogeneous recovery?

Cited by 16 publications

References 5 publications

COVID-19 outcomes in patients waitlisted for kidney transplantation and kidney transplant recipients

COVID-19 outcomes in patients waitlisted for kidney transplantation and kidney transplant recipients

COVID-19–Associated Mortality among Kidney Transplant Recipients and Candidates in the United States

COVID-19 pandemic: Building organisational flexibility to scale transplant programs

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