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J Clin Oncol ; : Jco2200461, 2022.
Article in English | PubMed | ID: covidwho-2140243


PURPOSE: The financial burden experienced by blood or marrow transplant (BMT) survivors during the COVID-19 pandemic remains unstudied. We evaluated the risk for high out-of-pocket medical costs and associated financial burden experienced by BMT survivors and a sibling comparison group during the COVID-19 pandemic. METHODS: This study included 2,370 BMT survivors and 750 siblings who completed the BMT Survivor Study survey during the pandemic. Participants reported employment status, out-of-pocket medical costs, and financial burden. Medical expenses ≥ 10% of the annual household income constituted high out-of-pocket medical costs. Logistic regression identified factors associated with high out-of-pocket medical costs and financial burden. RESULTS: BMT survivors were more likely to incur high out-of-pocket medical costs (11.3% v 3.1%;adjusted odds ratio [aOR], 2.88;95% CI, 1.84 to 4.50) than the siblings. Survivor characteristics associated with high out-of-pocket medical costs included younger age at study (aOR(per_year_younger_age), 1.02;95% CI, 1.00 to 1.03), lower prepandemic annual household income and/or education (< $50,000 US dollars and/or < college graduate: aOR, 1.96;95% CI, 1.42 to 2.69;reference: ≥ $50,000 in US dollars and ≥ college graduate), > 1 chronic health condition (aOR, 2.82;95% CI, 2.00 to 3.98), ≥ 1 hospitalization during the pandemic (aOR, 2.11;95% CI, 1.53 to 2.89), and being unemployed during the pandemic (aOR, 1.52;95% CI, 1.06 to 2.17). Among BMT survivors, high out-of-pocket medical costs were significantly associated with problems in paying medical bills (aOR, 10.57;95% CI, 7.39 to 15.11), deferring medical care (aOR, 4.93;95% CI, 3.71 to 6.55), taking a smaller dose of medication than prescribed (aOR, 4.99;95% CI, 3.23 to 7.70), and considering filing for bankruptcy (aOR, 3.80;95% CI, 2.14 to 6.73). CONCLUSION: BMT survivors report high out-of-pocket medical costs, which jeopardizes their health care and may affect health outcomes. Policies aimed at reducing financial burden in BMT survivors, such as expanding access to patient assistance programs, may mitigate the negative health consequences.

American Journal of Transplantation ; 22(Supplement 3):404, 2022.
Article in English | EMBASE | ID: covidwho-2063367


Purpose: The OPTN DTAC, a multidisciplinary group, evaluates potential donor derived transmission events (PDDTE) to assess the likelihood of disease transmission. Method(s): Retrospective study of PDDTE cases reported to the OPTN between 01/20 and 12/20. DTAC reviewed cases using a standardized classification algorithm. Result(s): During 2020, there were 18,318 donors and 37,583 unique recipients. DTAC reviewed 261/427 PDDTE from donor (111) or recipient (150) findings. 64/261 (25%) donors had proven/probable transmission (P/P Tr) of infection, malignancies or other to 84/206 (41%) exposed recipients [figure]. 12 involved living donors. Infection occurred with 44/64 P/P cases affecting 63 recipients. Viruses were most frequent P/P infections with 29 recipients having P/P Tr from 19 donors. COVID-19 PDDTE represented 11% (29/261) of all cases reviewed involving 29 donors and 15 lung and 76 non-lung recipients. One lung recipient had P/P Tr and died;none of the non-lung recipients developed P/P Tr. For bacteria, 20 recipients had P/P Tr from 14 donors. Deaths from infection (N=10) occurred at a median of 20 days (5-89 days). Attributable death was highest for fungal (4/12, 33%) and bacterial infections (6/20, 30%). 7 donors with malignancies were classified as P/P impacting 15 recipients with 1 attributable death. 53 non-infection, non-malignancy PDDTE were reported;13 resulted in P/P Tr to 14 recipients. Conclusion(s): Although P/P events remain rare, 1/4 reviewed cases resulted in unanticipated P/P Tr. This is a conservative estimate due to passive reporting and empiric interventions. In 29 COVID-19 PDDTE only 1 lung recipient had P/P Tr. The DTAC continues to evaluate PDDTE to maximize organ use and minimize the risk of transmission. (Table Presented).

American Journal of Transplantation ; 22(Supplement 3):333, 2022.
Article in English | EMBASE | ID: covidwho-2063353


Purpose: Decision to transplant organs from SARS-CoV-2 NAT+ donors(N+D) balances risk of donor-derived infection with the scarcity of available organs to meet the needs of waitlisted candidates. Method(s): OPTN Ad Hoc Disease Transmission Advisory Committee (DTAC) reports on the use of organs from N+D from the onset of required SARS-CoV-2 lower respiratory tract(LRT) testing for lung donors (May 27, 2021) through August 31, 2021. OPTN data were analyzed for donors with a positive LRT or upper respiratory tract (URT) test reported in DonorNet discrete data fields (N+D), compared with donors who did not have positive LRT or URT in the discrete data fields (N-D). Result(s): Organs were recovered from 120 N+D (all OPTN Regions and 40/57 OPOs (70%)). Median donor age was 42 (IQR: 32-52) for N+D and 43 (30-56) for N-D. There was a greater proportion of DCD N+D than N-D (37.5% vs 28.3%, p=0.04). Underlying COD of anoxia and other were different (N+D 31.7%, 16.7% vs N-D 48%, 2.7%, respectively). Transplanted N+D and N-D did not differ by KDPI, LDRI or LVEF for kidney(KT), liver(LT) or heart(HT), respectively (Table 1). Median time from donor admission to first reported test (any result) was 0 and 4 days for URT and LRT, respectively. N+D recovery occurred a median of 2 (IQR: 1-6) days from last positive test. 246 organs (152KT, 50LT, 22HT, 22other) were transplanted from 107 N+D compared to 8969 organs from 3348 N-D. Recipients from N+D and N-D were similar in age, MELD/PELD (LT) and medical urgency status (HT). Median time from listing to transplant similar for N+D for all organs. The match run sequence number for final acceptor was higher for N+D for all organ types (Table 2). Median length of stay was similar for N+D and N-D for KT and LT (5d and 12-13d, respectively). For HT, median stay was shorter for N+D (30 vs 34d). For N+D, 3 of 50 LT died within 30d of transplant. During this timeframe, no PDDTEs were reported for any N+D at the time of transplant. Conclusion(s): N+D and N-D were similar in terms organ quality characteristics. Recipients receiving organs from N+D had higher match run sequence numbers, suggesting use of organs from N+D is not widespread across centers;however, with small numbers, this data will need to be verified. We cannot assess the relatedness of the three early mortality events in N+D recipients to donor or recipient characteristics. However, these data highlight the importance of ongoing outcome review of N+D recipients. (Figure Presented).

American Journal of Transplantation ; 21(SUPPL 4):351, 2021.
Article in English | EMBASE | ID: covidwho-1494443


Purpose: US Solid organ transplantation rates significantly decreased during the initial wave of the COVID-19 pandemic. The concern for potential donor derived COVID-19 was one of many contributing factors. We describe the early experience of the Organ Procurement and Transplantation Network (OPTN) Disease Transmission Advisory Committee (DTAC) Coronavirus disease 2019 (COVID-19) investigations. Methods: COVID-19 cases reported to DTAC between January 2020 and October 2020 as potential donor-derived transmission events (PPDTE) were included. All of the events were investigated by the Centers for Disease Control and Prevention and adjudicated by the DTAC based on consensus definitions. Results: Eighteen PDTE COVID-19 events were reported during the study period. 12 PDTE reports have completed DTAC adjudication (Table 1). These included 12 donors with 44 recipients. Ten investigations were initiated by the transplant center due to recipient testing (36 total recipients). The median time to presentation in these index cases was 11 days (IQR 7-16). Nine donors in these events (35 recipients) had a prospective or retrospective pre-recovery negative SARS-CoV-2 PCR result. In all of these events, the index recipient had either a possible or confirmed community or hospital exposure. In one recipient index case (5 total recipients), the positive SARS-CoV-2 PCR result post-transplant was ultimately deemed a false positive and considered not a case by the committee. Two investigations were initiated by an OPO (8 recipients). In both events, the OPO performed SARS-CoV-2 PCR was negative, but a post-procurement nasopharyngeal SARS-CoV-2 PCR performed by the tissue collector was reported as positive and retrospectively deemed false positives. None of these recipients developed COVID-19;the events were adjudicated as not cases. Conclusions: The initial DTAC experience reflecting the early pandemic era emphasizes the need to implement hospital prevention measures to avoid nosocomial transmission, provide patient education to avoid community exposure and to recognize the possibility of post-procurement SARS-CoV-2 false positive testing. Vigilance for the possibility of a SARS-CoV-2 donor derived event remains important as the pandemic continues. (Table Presented) .