Dialysis staff-reported impact of the early COVID-19 pandemic on kidney transplant referrals and evaluations

Purpose: COVID-19 has drastically impacted healthcare systems since its declaration as a pandemic in March 2020. Evidence of this impact persists among solid organ transplant programs, with vast disruptions to kidney transplant reported nationwide. Little is known about the influence of COVID-19 on early transplant steps occurring at the dialysis facility level. We sought to describe the staff-reported impact of COVID-19 on kidney transplant referrals and evaluations. Methods: A cross-sectional survey was emailed to n=579 dialysis facility staff in ESRD Network 6 (Georgia, North Carolina, and South Carolina) in April 2020. Responses were linked to 2015-2018 Centers for Medicare and Medicaid Services Dialysis Facility Report data, and patient and facility characteristics were compared using t-tests, Wilcoxon rank-sum tests, and chi-square tests. Results: Among 280 survey responses received from unique dialysis facilities, 28.9% of respondents disclosed that transplant referrals were affected by COVID-19, and 60.4% described transplant evaluations as affected (Table 1). When describing barriers to quality improvement activities due to COVID-19, the most prominent concerns were “dependent institutions not operating as usual” (48.6%), an “over- whelmed healthcare system” (33.6%), and transportation issues (26.8%). Facilities were comparable with regards to patient and facility demographic, clinical, and socioeconomic characteristics. Conclusions: Our findings provide further evidence that kidney transplant has been substantially affected by the COVID-19 pandemic, even at the dialysis facility level. Policies surrounding transitions to normal operations among dialysis facilities in the Southeastern United States must consider the long-term implications of these delays related to transplant access. (Table Presented).

Solid organ transplant recipients and healthcare burden in covid19 era

Purpose: Pneumonia(PNA)-Acute inflammation of the lung parenchyma from an infection, is a frequent cause for hospitalization among Solid Organ Transplant Recipients (SOTRs), adversely effecting patient survival and healthcare costs. We assessed the healthcare impact associated with intensive care unit (ICU) hospitalization amongst SOTRs with COVID19 PNA or other serious PNAs. Methods: We performed a single center retrospective analysis of SOTRs admitted to the ICU with any PNA during March 2019-October 2019 or with COVID19 PNA during March 2020-October 2020. Using t-tests and Chi Square tests we compared SOTRs with severe COVID19 PNA to those with other severe PNAs. Results: 53 SOTRs with severe PNAs were included: 26 with COVID19 PNA and 27 with other PNAs (Bacterial 56%, Fungal 30%, Viral 14%). Both the groups were similar in demographics, time since transplant, length of stay and acute dialysis needs (Table 1). Mortality was higher in SOTRs with COVID19 PNA compared to other PNAs (46% Vs 22%;p 0.07). Hospitalization costs was greater in those with other PNAs compared to COVID19 PNAs ($553,000 VS $196,000;p 0.006) with fungal PNAs being associated with greatest costs (Figure1). Conclusions: Critically ill SOTRs have substantially burdened the healthcare system with COVID19 associated mortality and healthcare expenses with other infections of equal severity. Every effort must be made to ensure timely assessment and diagnosis to minimize healthcare strains during this pandemic.