Living organ donor perspectives on COVID-19 vaccines

Purpose: Promoting widespread COVID-19 vaccinations is a crucial strategy to protect living organ donors and transplant recipients during the pandemic. We examined perspectives and sources of hesitancy about COVID-19 vaccines among former and prospective living organ donors. Methods: We conducted an IRB-approved study of US living organ donors and prospective donors. An online survey was disseminated on multiple social media platforms between 12/28/20-2/9/21. Survey items included multiple choice, ranking, and ratings of agreement to statements about COVID-19 vaccine effectiveness, convenience, and importance. We used descriptive statistics and a multivariable logistic regression model to examine associations between respondent characteristics and preferences and COVID-19 vaccine acceptance. Results: Among 323 respondents from 40 US states and DC, 53% were 31-50 years old, 91% were non-Hispanic white, and 88% were female. Respondents included 267 living donors (94% kidney) and 56 in evaluation to donate (75% kidney). When asked if they would accept a COVID-19 vaccine, 76% answered yes, 11% no, and 13% unsure. Compared to those who would decline a vaccine or are unsure, respondents who would accept a vaccine were more likely to receive yearly influenza vaccines (48% vs 83%, p<0.001) and rely on public health officials for information (4% vs 35%, p<0.001). Respondents who relied on information sources other than public health officials were less likely to agree that COVID-19 vaccines are safe, effective, adequately studied or that donors and recipients should receive COVID-19 vaccines (Figure). Adjusting for demographics, education, and donor type, prioritization of public health officials for information and acceptance of yearly influenza vaccines were independently associated with higher COVID-19 vaccine acceptance (p<0.001 for both). The association between public health official guidance and higher COVID-19 acceptance was similar among respondents who do and do not receive yearly influenza vaccines (adjusted marginal probabilities of vaccine acceptance of 97% and 94%, respectively). Conclusions: Living organ donors who prioritize information from public health officials are more likely to accept a COVID-19 vaccine than those who rely on other information sources. Transplant programs could incorporate public health messaging and education when discussing the risks and benefits of COVID-19 vaccination. (Table Presented).

Characteristics and outcomes of patients with COVID-19-related critical illness

INTRODUCTION: To describe the epidemiology of Coronavirus Disease 2019 (COVID-19)-related critical illness at a diverse academic health system. METHODS: We performed a single-health system, multihospital retrospective cohort study of patients with COVID- 19-related critical illness who were admitted to an intensive care unit (ICU) at any of five hospitals within the University of Pennsylvania Health System. We report descriptive statistics for patient demographics, comorbidities, acute physiology parameters, receipt of ICU therapies, hospital outcomes, and survivorship. Using multivariable linear and logistic regression, we evaluated trends over time in all-cause 28-day in-hospital mortality, the primary outcome, and in patient acuity, and we evaluated candidate prognostic risk factors for association with mortality. RESULTS: 468 patients with COVID-19-related critical illness had a median age of 65 years (interquartile range [IQR] 54-74), were more likely male (57.7%), were more likely Black race (52.8%), and had a high co-morbidity burden (71.8% with ≥ 2 points on the Charlson Comorbidity Index). At least once during their hospitalization, 319 (68.2%) patients were treated with mechanical ventilation and 121 (25.9%) with vasopressors. Outcomes were notable for 29.9% all-cause 28-day in-hospital mortality (37.0% among those who received mechanical ventilation and 14.8% among those who did not receive mechanical ventilation), 8-day (IQR 3-17) median ICU length of stay, 13-day (IQR 7-25) median hospital length of stay, and 10.8% all-cause 30-day readmission rate. Mortality decreased over time from 43.5% (95% confidence interval 31.3%-53.8%) to 19.2% (11.6%- 26.7%) between the first and last 15-day periods in the fully adjusted model. Risk factors at ICU admission prognostic for mortality included increasing age, peripheral vascular disease, low or high body mass index, abnormal mental status, hypoxemia, tachypnea, and thrombocytopenia. CONCLUSIONS: Among patients with COVID-19-related critical illness admitted to the ICU at an academic health system in the U.S., a finite set of patient-level factors were prognostic for mortality and mortality decreased over time.

Living donor kidney transplant practice in the COVID-19 era: A survey of us transplant programs

Background: We surveyed U.S. transplant programs to assess practices, strategies and barriers related to living donor kidney transplantation (LDKT) in the context of the COVID-19 pandemic. Methods: After IRB approval, the survey was launched 5/9/20 by email and postings to professional society list-servs, using the Qualtrics platform. Data are reported through 5/27/20, and examined by state COVID-19 prevalence. Results: Staff at 117 unique centers responded, representing 58% of U.S. living donor recovery centers and 75% of LKDT volume in the year before pandemic declaration. Overall, 66% reported LDKT surgery was on hold (82% in high vs. 50% in low prevalence states). 36% reported that evaluation of new donor candidates had paused, 27% reported evaluations were very decreased (>0% to <25% typical) and 23% reported evaluations were moderately decreased (25% to <50% typical). Barriers to LDKT surgery included program concerns for donor (84%) and recipient (75%) safety, patients concerns (54%), restrictions on elective cases (47%) and hospital administrative restrictions (47%). Programs with higher local COVID-19 prevalence reported more barriers related to staff and resource diversion (Figure). Most centers continuing donor evaluations used remote strategies (video 82%;telephone 43%). 61% of centers plan to continue more telehealth after the pandemic. 32% plan to resume some LDKT within 2 wks and 27% within 1 month. When surgery resumes, all will screen for COVID-19 before donation surgery, although timeframe and modalities vary. Conclusions: COVID-19 has created many barriers to LDKT, especially in areas of highest prevalence. Transplant centers are planning to restart LKDT cautiously. Consensus-building is needed to reduce barriers, guide optimal practice, and facilitate safe restoration of LDKT across centers.

Living organ donor perspectives on organ donation during the COVID-19 pandemic

Background: Due to the COVID-19 pandemic, transplant programs across the U.S. postponed living donor surgeries and transplants. We examined perspectives of former and prospective living organ donors on the risks and excess burdens of organ donation during the COVID-19 pandemic. Methods: In late April 2020, we disseminated an IRB-approved survey to a national online forum of over 1300 living donors and those in workup for donation. Using visual analog scales, respondents rated sources of information about COVID-19, burdens on donors due to the pandemic, and what factors should determine whether living donation should proceed during the pandemic (0=unimportant, 100=very important). Results: After 4 weeks, there were 101 respondents from 35 U.S. states;63% were between 31-50 years old, 95% were non-Hispanic white, and 90% were female. Respondents included 68 living donors (72% kidney) and 33 people in work-up to donate (73% kidney). The most and least important sources of information about COVID-19 were personal doctors (median importance 88, IQR 73-100) and social media (median 26, IQR 12-54), respectively. Nearly half (41%) were unsure of their transplant program's policy for living donation during the pandemic, and 58% reported that the decision to donate during COVID-19 should depend on factors such as transplant candidate health (median 100, IQR 90-100) and availability of COVID-19 tests (median 84, IQR 70-95). Respondents rated concern for transplant candidates and loss of employer-based health insurance as the most important pandemic-related stressors for donors (Figure). Conclusions: Many living organ donors were uncertain about their transplant program's approach for donation during the pandemic. Donors were concerned about the health of transplant candidates and financial stressors, and prioritized availability of COVID-19 testing to determine when living donation should proceed during the pandemic.