ABSTRACT
Background: The SARS-CoV2 pandemic increased the complexity of delivering clinical care and laboratory services for immunosuppressed kidney transplant (KTx) recipients. We evaluated how the pandemic impacted adherence with laboratory draws among patients in the Kidney allograft Outcomes AlloSure Registry (KOAR,NCT03326076). Method(s): 1663 KTx recipients undergoing post-transplant surveillance using donorderived cell-free DNA (dd-cfDNA) were enrolled in KOAR between 2017 and 2021. Participating centers were free to individualize their surveillance strategies. We estimated adherence by using the pre-pandemic distribution of surveillance dd-cfDNA draws across participating sites to establish a baseline regimen, and then compared adherence before the pandemic (P1;through 1/2020) with two subsequent periods in 2020: P2 (2/2020 - 6/2020), coinciding with the first wave of infections, and P3(7/2020 - 12/2020), which captures the bulk of the second and third waves in the US. Result(s): The distribution of surveillance dd-cfDNA draws at participating sites before COVID (P1) identified 7 peaks corresponding to draw points at months 1, 2, 3, 4, 6, 9, and 12 [Figure 1a]. Estimated adherence during P1 based on this regimen was 60.5%. Over the subsequent 5 months (P2), reflecting the early months of the pandemic, adherence declined to 50.5% (p < 0.01). After the expanded availability of mobile phlebotomy services in 7/2020 and despite rising SARS-CoV2 case counts and hospitalizations, adherence during P3 improved to 57.6% (p < 0.01 compared to P2, p = 0.1 compared to P1) [Figure 1b]. Conclusion(s): Our findings demonstrate that adherence to laboratory surveillance among transplant recipients enrolled in the KOAR registry declined in theearly period of the SARS-CoV2 pandemic, however, a variety of adaptations in the latter half of 2020, including the widespread availability of remote phlebotomy for these patients, appears to have led to substantial improvements, with adherence approaching pre-pandemic levels. (Figure Presented).
ABSTRACT
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.