ABSTRACT
Background: The Organ Procurement and Transplantation Network requires documentation of SARS-CoV-2 (COVID) testing status for each potential donor and lower respiratory specimen testing with nucleic acid tests for all donor lungs. In the absence of guidelines for the use of COVID-positive donor kidneys, we sought to examine the clinical characteristics of COVID-positive donors and trends in the utilization of COVID-positive donor kidneys. Method(s): This study used Scientific Registry of Transplant Recipients data and included all deceased donors (n=24,940) and recipients (n= 29,478) from June 1, 2020, through April 2, 2022. Variation in donor and recipient characteristics were considered significant at P<.05. Result(s): 1,310 (5.35%) of donors during the observation period had a positive test for COVID-19 with 1,731 (67.70%) kidneys transplanted, 108 (4.22%) not recovered, and 714 (27.92%) recovered but not transplanted. COVID-positive donors differed from COVID-negative or untested donors in terms of race, ethnicity, cause of death, and donation after circulatory death status (all P < .05). 813 recipients (2.76%) received COVID-positive deceased donor kidneys. Recipients of COVID-positive donor kidneys were more likely to be White, not have received a previous transplant, and had greater cold ischemic times (all P < .05). The number of transplants with COVID-positive donors peaked in early 2022 (Figure 1). Adjusted hazard ratios for all-cause graft failure with COVID-positive donors and death were 0.89 (95% CI, 0.62-1.28) and 0.87 (95% CI, 0.52-1.46), respectively. Conclusion(s): Transplant with COVID-positive donor kidneys increased during the study period and is not associated with increased risks for recipients. However, high discard rates for COVID-positive donors and greater cold ischemic times may suggest that such donor kidneys remain difficult to place. Patient- and transplant program-level interventions targeting decision support and risk aversion may be necessary to reduce discard rates for COVID-positive donor kidneys. (Figure Presented).
ABSTRACT
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.