OPTN/SRTR 2020 Annual Data Report: Liver.

This year was marked by the COVID-19 pandemic, which altered transplant program activity and affected waitlist and transplant outcomes. Still, 8906 liver transplants were performed, an all-time high, across 142 centers in the United States, and pretransplant as well as graft and patient survival metrics, continued to improve. Living donation activity decreased after several years of growth. As of June 30, 2020, 98989 liver transplant recipients were alive with a functioning graft, and in the context of increasing liver transplant volume, the size of both the adult and pediatric liver transplant waitlists have decreased. On February 4, 2020, shortly before the pandemic began, a new liver distribution policy based on acuity circles was implemented, replacing donor service area- and region-based boundaries. A policy change to direct pediatric livers to pediatric recipients led to an increase in deceased donor transplant rates and a decrease in pretransplant mortality rate among children, although the absolute number of pediatric transplants did not increase in 2020. Among adults, alcohol-associated liver disease became the predominant indication for liver transplant in 2020. After implementation of the National Liver Review Board and lower waitlist priority for most exception cases in 2019, fewer liver transplants were being performed via exception points, and the transplant rate between those with and without hepatocellular carcinoma has equalized. Women continue to experience higher pretransplant mortality and lower rates of liver transplant than men.

OPTN/SRTR 2020 Annual Data Report: Heart.

As we enter the third year of the new adult heart allocation policy, we are faced with the new challenges of the COVID-19 pandemic. In 2020, new listings (adult and pediatric) decreased slightly, with 4000 new listings in 2020, compared with 4087 in 2019; however, the number of adult heart transplants performed continued to increase, to 3715 in 2020. The number of pediatric heart transplants declined from 509 in 2019 to 465 in 2020. One-year and six-month posttransplant mortality rates in adult recipients have increased slightly since 2015 but have not significantly changed over the past decade. Overall, posttransplant mortality rates for adult recipients were 7.4% at six months and 9.4% at one year for transplants in 2019, 14.0% at three years for transplants in 2017, and 19.1% at five years for transplants in 2015. Although shorter-term posttransplant mortality rates have slightly increased, there has been a steady downward trend in longer-term mortality. Mortality rates for pediatric recipients were 5.7% at six months and 8.1% at one year for transplants in 2019, 11.6% at three years for transplants in 2017, and 15.2% at five years for transplants in 2015.

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.