Prevalence and Characteristics of Covid-19-Associated Pulmonary Diagnoses in Lung Transplant Patients in the United States

Purpose: Lung transplant may be a viable treatment option for select patients with non-recoverable COVID-19-associated acute respiratory distress syndrome (ARDS) and COVID-19-associated pulmonary fibrosis. This study aims to characterize the utilization and outcomes of lung transplant among patients with COVID-19- associated ARDS and pulmonary fibrosis. Method(s): We analyzed the Organ Procurement Transplant Network database to characterize the prevalence and characteristics of patients with COVID-19-associated ARDS and pulmonary fibrosis who were added to the waiting list and/or received a lung transplant between March 13, 2020 and July 31, 2021. Result(s): We found that 207 lung candidate registrations were added to the waiting list and 182 lung transplants were conducted for patients with COVID-19-associated ARDS or pulmonary fibrosis. The majority of lung candidates and lung transplant recipients with COVID-19-associated diagnoses were male, had private insurance, were disproportionately Hispanic and had a higher lung allocation scores (LAS) compared to patients with non-COVID-19 diagnoses. There was no significant difference in 30-day post-transplant survival among recipients with COVID-19- associated diagnoses compared to non-COVID-19 diagnoses. Conclusion(s): Future research on post-transplant outcomes among lung transplant recipients with COVID-19-associated diagnoses is warranted. Further study of outcomes may assist in refining the appropriate LAS waitlist mortality and posttransplant survival scoring for these patients. (Figure Presented).

OPTN/SRTR 2020 Annual Data Report: Lung.

For the first time in a decade, both the number of candidates added to the waiting list and the number of lung transplants performed decreased from the year prior; the number of lung donors also declined. This slowing of transplant activities in 2020 was associated with a modest increase in waitlist mortality. The year 2020 was notable for the global outbreak of the COVID-19 pandemic, which undoubtedly influenced all trends noted in lung transplantation. Time to transplant continued to decrease, with a median time to transplant of 1.4 months across all waitlist candidates. Posttransplant survival remained stable, with 89.4% of transplant recipients surviving to 1 year, 74.8% to 3 years, and 61.2% to 5 years.

Impact of COVID-19 crisis on disparities in living kidney donation in the US

Purpose: The COVID-19 pandemic resulted in a dramatic decrease in living kidney donation (LKD) in the U.S. This study investigated the effect of the COVID crisis on characteristics of LKD recipients in the U.S. Methods: We used OPTN transplant and LKD data to compare proportions of LKD recipients' race, SES (neighborhood income), sex, dialysis status, age, and recipient/ donor sex match during 3 eras: Pre-COVID (1/1/20-3/12/20, n=1294);COVID Shutdown (3/13/20-5/9/20, n=173);and COVID Stabilization (5/10/20-11/15/20, n=2331;Table 1). Results: Contrary to our expectations, LKD recipients' race, neighborhood income, and dialysis status at transplant did not differ by era (Figure 1a-c;Table 2). We did, however, find a significant relationship between recipient sex and era, with a higher proportion of male recipients in the COVID Shutdown and COVID Stabilization eras than in the Pre-COVID era (Figure 1d). We found a related significant association between recipient/donor sex match and era, with a higher proportion of male-recipient/female-donor transplants and a lower proportion of female-recipient/ female-donor transplants in the COVID Shutdown and COVID Stabilization eras than in the Pre-COVID era (Figure 1e). There was a marginally significant relationship between recipient age at transplant and era, with a higher proportion of younger recipients in the COVID Shutdown era than in the Pre-COVID and COVID Stabilization eras (Figure 1f). Conclusions: While we did not find expected differences in areas of current disparities such as LKD recipient race or SES, we did find that the drop in living donation caused by the COVID crisis exacerbated previously existing disparities in recipient sex and recipient/donor sex match, suggesting that COVID has not had an equal effect on all candidates. (Table Presented).