ABSTRACT
Purpose: The COVID-19 pandemic led to a decrease in transplantation throughout the United States. We examined the impact of the pandemic in regards to the volume of pediatric donors from which livers were successfully transplanted and donor characteristics during this time. Methods: The UNOS database was examined between 3/1/2019-8/1/2019 (non-COVID era) and 3/1/2020-8/1/2020 (COVID era). The numbers of potential pediatric donors and those who donated livers were determined. Donor demographic data was obtained. STATA software was used to perform statistical analysis. A p-value of <0.05 was considered to be significant. Results: There was a 12% decrease in referral numbers of pediatric liver donors between the non-COVID period (n=440) and the COVID period (n=389). Additionally, overall (25% vs. 27% ) and intraoperative (10% vs. 11%) discard rates were higher resulting in a 14% reduction in livers for transplant between non-COVID and COVID periods. Patterns were not uniform across the country. Region 5 had an increase in donors from the non-COVID to COVID era (6.25%), while region 10 had the greatest decrease in donors (15%). Analysis of donor data did not show differences in age (10.9 vs. 11.1 y), BMI (21.7 vs. 21.2 kg/m2), AST (94 vs. 101 U/L), ALT (107 vs. 84 U/L), whole organ use (94.7% vs. 96.7%), DCD status (7.8% vs. 7.3%), or IRD status (14.8% vs. 13.0%) between COVID and non-COVID periods. Macrosteatosis (3.7% vs. 12.6%) was lower in the COVID period although few livers underwent biopsy. Interestingly, the DRI was significantly higher in the COVID period (1.77 vs. 1.60, p = 0.001) with a greater proportion of higher risk donors (DRI>2) used during COVID (24%) compared to non-COVID (20%). Conclusions: During the COVID period there was a large decrease in pediatric donor referral. It appears that this promoted utilization of livers with higher overall donor risk by liver transplant centers.
ABSTRACT
Purpose: With the onset of the COVID-19 pandemic, many people in the United States were urged to stay at home. Kidney transplantation continued during this time, albeit at a reduced pace. We examined if there was increased utilization of belatacept during the pandemic in fresh transplant recipients, as this would potentially decrease need for blood draws for monitoring medication troughs. Methods: The UNOS STARfile was queried to examine all patients who received a kidney transplant between 3/1/2020 - 5/31/2020 (COVID era, COVID). All kidney transplants performed during 3/1/2019 - 5/31/2019 were defined as the pre- COVID era (Pre). In each era, patients were divided based upon belatacept (Bela) immunosuppression vs. non-belatacept (N) immunosuppression. The four groups examined included COVID/belatacept (COVID-Bela), pre-COVID/belatacept (Pre- Bela), COVID/non-belatacept (COVID-N), and pre-COVID/non-belatacept (Pre-N). Results: There were 9563 transplants performed over both periods, of which 4171 (43.6%) were performed during COVID (118 or 2.8% COVID-Bela, 4053 or 97.2% COVID-N) and 5392 were performed pre-COVID (56.4%) (153 or 2.8% with Pre-Bela, 5239 or 97.2% Pre-N). Donor KDPI was significantly higher in both belatacept groups (57% COVID-Bela, 58% Pre-Bela vs. 44% COVID-N, 47% Pre- N, p<0.0001), along with a longer cold storage time (19.6 h COVID-Bela, 17.3 h Pre-Bela vs. 15.1 h COVID-N, 13.7 Pre-N, p<0.0001) and higher donor creatinine (1.66 mg/dL COVID-Bela, 1.63 mg/dL Pre-Bela vs. 1.33 mg/dL COVID-N, 1.32 mg/dL Pre-N, p<0.002). Recipients in the belatacept groups were also significantly older (55.8 y COVID-Bela, 55.2 y Pre-Bela vs. 51.9 y COVID-N, 52.9 y Pre-N, p<0.0001), had a higher EPTS (0.53 COVID-Bela, 0.50 Pre-Bela vs. 0.46 COVID-N, 0.47 Pre-N, p=0.03), higher creatinine at discharge (5.68 mg/dL COVID-Bela, 4.37 mg/dL Pre-Bela vs. 4.20 mg/dL COVID-N, 3.74 mg/dL Pre-N, p<0.0001), and greater delayed graft function (DGF) (42.4% COVID-Bela, 30.7% Pre-Bela vs. 23.1% COVID-N, 23.2% Pre-N, p<0.0001). Regions 3, 4, and 5 had the greatest utilization of belatacept during the COVID era at 29.7%, 25.4%, and 8.5%, respectively. Conclusions: Despite stay at home recommendations, utilization of belatacept did not increase during the COVID era. Belatacept immunosuppression continued to be used in higher KDPI kidneys in older recipients as had been done in the pre-COVID era. Transplantation during COVID brought longer cold storage times and greater DGF, but belatacept potentially has allowed utilization of kidneys that might have otherwise been discarded during the COVID era.