ABSTRACT
Purpose: The OPTN temporarily suspended follow-up reporting requirements on 4/3/20 (retroactive to 3/13/20) in response to the COVID-19 crisis. We assessed the policy's impact on living donor follow-up form (LDF) and lab data submission for donors who have historically been disadvantaged in the transplant system. Methods: We analyzed OPTN data as of 1/22/20 for all 6-, 12-, and 24-month LDFs expected between 3/13/20-12/31/20 (“COVID”) vs 3/13/19-12/31/19 (“pre-COVID”). We assessed status of COVID forms by donor demographics. We also compared proportions of validated forms with complete lab data by era and donor demographics. Results: 15.6% of kidney and 10.8% of liver LDFs were in amnesty status, with substantial variation by center. Kidney: We found significant differences in form status by race/ethnicity (p<0.001), gender (p=0.007), age group (p<0.001), neighborhood income quartile (p=0.001), and relationship to recipient (p<0.001), with greater proportions of forms in amnesty status for Black (Black: 19.3%;White: 15.6%;Hispanic: 13.7%;Other: 14.6%), male (male: 16.7%;female: 15.0%), younger (age 18-34: 16.9%;35-49: 16.4%;50-64: 13.9%;65+: 13.7%), lower-income (Q1: 18.3%;Q2: 15.6%;Q3: 15.9%;Q4: 14.6%), biologically related and paired donors (biologically related: 16.8%;paired: 17.6%;spousal: 12.1%;unrelated: 14.5%) (Table 1). Liver: Younger donors had greater proportions of forms in amnesty status (age 18-34: 12.9%;35-49: 10.0%;50-64: 6.4%;p=0.056). Pre-COVID demographic differences in forms with complete lab data persisted during COVID, compounded by amnesty forms (Figure 1). Conclusions: Centers have voluntarily submitted over 80% of expected LDFs under this emergency policy. However, our finding that a disproportionate number of forms are missing for donors who are Black, male, younger, lower SES, and biological relatives of their recipient is concerning. These groups are at greater risk of long-term complications after donation, and may have limited access to health services during the pandemic and risk being lost to follow-up. Centers should consider targeted follow-up efforts for at-risk groups. (Table Presented).