The Global Impact of COVID-19 on Solid Organ Transplantation: Two Years Into a Pandemic

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has had a major global impact on solid organ transplantation (SOT). An estimated 16% global reduction in transplant activity occurred over the course of 2020, most markedly impacting kidney transplant and living donor programs, resulting in substantial knock-on effects for waitlisted patients. The increased severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection risk and excess deaths in transplant candidates has resulted in substantial effort to prioritize the safe restart and continuation of transplant programs over the second year of the pandemic, with transplant rates returning towards prepandemic levels. Over the past 2 y, COVID-19 mortality in SOT recipients has fallen from 20%–25% to 8%–10%, attributed to the increased and early availability of SARS-CoV-2 testing, adherence to nonpharmaceutical interventions, development of novel treatments, and vaccination. Despite these positive steps, transplant programs and SOT recipients continue to face challenges. Vaccine efficacy in SOT recipients is substantially lower than the general population and SOT recipients remain at an increased risk of adverse outcomes if they develop COVID-19. SOT recipients and transplant teams need to remain vigilant and ongoing adherence to nonpharmaceutical interventions appears essential. In this review, we summarize the global impact of COVID-19 on transplant activity, donor evaluation, and patient outcomes over the past 2 y, discuss the current strategies aimed at preventing and treating SARS-CoV-2 infection in SOT recipients, and based on lessons learnt from this pandemic, propose steps the transplant community could consider as preparation for future pandemics.

Impact of the COVID-19 Pandemic on Solid Organ Transplant and Rejection Episodes in Brazil’s Unified Healthcare System

“…This could be explained by the unavailability of intensive care beds, fewer deceased brain trauma donors, and concerns about COVID-19 infection for solid organ transplant patients [ 4 ]. Transplant rates are returning to pre-pandemic levels in some countries, as a result of significant advances in the management of COVID-19, especially during the second year of the pandemic [ 13 ]. Despite these advances, Brazil faces difficulties returning to the pre-pandemic transplant levels.…”

Transplantation of solid organs recovered from deceased donors recently infected by SARS-CoV-2 in the United States

“…As such, recommendations were made at the time to reserve deceased-donor kidney transplantation for life-saving indications 15 . Advances in COVID-19 diagnostics, therapeutics, and prevention have led to improvement of most of these trends 16 .…”

Ethical Issues in Kidney Transplant and Donation During COVID-19 Pandemic

“…14 The trend of reduced transplantation after 2020, including burnout in transplant workforces and the impact of increase in incidence of infection in kidney transplant recipients secondary to omicron variant, remains to be evaluated and monitored. 15,16 Deferring elective surgical or medical procedures during the Covid-19 crisis is justified ethically to protect patients and healthcare workers (non-maleficence and distributive justice as resources and staff were not available for elective and even many emergency services). There was an unknown risk in the beginning of Covid-19 infection (pre-vaccination era) for immunosuppressed patients.…”