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American Journal of Transplantation ; 22(Supplement 3):533-534, 2022.
Article in English | EMBASE | ID: covidwho-2063398


Purpose: VCA transplantation has grown and changed, encountering challenges such as scarce funding sources and the COVID-19 pandemic. Method(s): The OPTN cohort includes 105 candidates listed and 62 recipients transplanted 7/4/14-10/31/21. Result(s): VCA candidates included 47 uterus, 26 upper limb (UL, 14 bilateral, 12 unilateral), 1 UL/face, 12 face, 1 scalp, 2 face/scalp, 1 trachea, 12 abdominal wall (AW), and 3 penis candidates. Waiting list additions increased in 2016 after uterus transplants began in the US. Head and neck and UL additions held relatively steady through 2019. The COVID-19 pandemic caused a decrease in VCA waiting list additions in 2020 - 1 AW, 1 uterus, and two UL candidates. In the first 10 months of 2021, 5 VCA candidates were added - 2 AW and 3 uterus candidates. In April 2020, 11 of 23 VCA candidates were inactive;on 10/31/2021, 8 of 21 were inactive. 62 candidates received 64 transplants (including 1 uterus re-transplant and 1 face/ UL transplant). Others refused transplant (n=7), became ineligible (n=4), could not be contacted (n=2), condition improved (n=1), were too sick (n=2), died (n=3), or were removed for other reasons (n=2). Median time on the waiting list for recipients was 217 days (IQR: 76.0-404.25 days). VCA transplants in the U.S. 7/3/14-10/31/21 include 14 UL (9 bilateral;5 unilateral), 9 face, 1 UL/face, 1 scalp, 1 trachea, 2 AW, 2 penis, and 33 uterus (12 deceased donor;21 living donor). In 2016, VCA shifted from mostly UL and face to a larger proportion of uterus transplants. UL and face transplants decreased in 2017, then increased and held steady through 2019. VCA transplants decreased in 2020 with the COVID-19 crisis and included 2 uterus transplants, the first U.S. face re-transplant, and the first successful UL/face transplant in the U.S. In the first 10 months of 2021, 2 living donor uterus, 1 bilateral UL, and the first trachea transplant in the US occurred. Out of 62 recipients, 21 were funded by the hospital, 15 by donations, 7 by Medicare/ Medicaid, 1 by Dept of Veterans Affairs, 3 by private insurance, and 2 by recipient. Conclusion(s): VCA transplantation continues to faces challenges such as the COVID-19 pandemic and chronic issues such as funding sources, but has shown signs of resilience in 2021. (Figure Presented).

American Journal of Transplantation ; 21(SUPPL 4):824, 2021.
Article in English | EMBASE | ID: covidwho-1494565


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).

American Journal of Transplantation ; 21(SUPPL 4):332-333, 2021.
Article in English | EMBASE | ID: covidwho-1494473


Purpose: Vascularized Composite Allograft (VCA) transplantation has grown and changed rapidly in the past several years. This study investigates VCA waiting list and transplant trends in the U.S. Methods: We used OPTN VCA waiting list data from July 3, 2014 through November 15, 2020 and OPTN VCA transplant data from January 1 1998 through November 15, 2020. Results: Since the OPTN implemented the VCA waiting list on July 3, 2014, 99 candidates have been registered on the waiting list through November 15, 2020. VCA candidates were 60.6% female, 79.8% white, and 78.8% under 45 years old, but characteristics varied by organ type. The size of the VCA waiting list increased gradually over several years, largely due to the introduction of uterus transplants. In the past year, however, existing registrations for upper limb and head and neck candidates held steady while uterus registrations declined. New registrations were notably lower in 2020, likely due to the COVID-19 crisis. As of 11/15/20, the OPTN VCA waiting list included 4 head and neck (20%), 6 upper limb (30%), 4 abdominal wall (20%), and 6 uterus (30%) candidates. Median days on the list for those waiting for a deceased donor organ on 11/15/20 was 771 days (IQR: 524.8 - 971.0) - a large increase compared with analyses at the same time in 2019. Median days on the VCA waiting list for those transplanted with a deceased donor organ was 193 days (IQR: 71.25 - 376.5). A total of 109 VCA recipients have received VCA transplants in the US, including 59 since 7/3/14: 8 bilateral upper limb, 5 unilateral upper limb, 10 face, 1 scalp, 2 abdominal wall, 31 uterus (12 deceased donor;19 living donor), and 2 penis transplants. Conclusions: Continued monitoring of VCA trends is needed to support VCA donation and transplantation.

American Journal of Transplantation ; 21(SUPPL 4):497, 2021.
Article in English | EMBASE | ID: covidwho-1494420


Purpose: The OPTN temporarily suspended follow-up reporting requirements on 4/3/20 (retroactive to 3/13/20) in response to the COVID-19 crisis. We assessed the policy's impact on living donor follow-up form (LDF) and lab data submission for donors who have historically been disadvantaged in the transplant system. Methods: We analyzed OPTN data as of 1/22/20 for all 6-, 12-, and 24-month LDFs expected between 3/13/20-12/31/20 (“COVID”) vs 3/13/19-12/31/19 (“pre-COVID”). We assessed status of COVID forms by donor demographics. We also compared proportions of validated forms with complete lab data by era and donor demographics. Results: 15.6% of kidney and 10.8% of liver LDFs were in amnesty status, with substantial variation by center. Kidney: We found significant differences in form status by race/ethnicity (p<0.001), gender (p=0.007), age group (p<0.001), neighborhood income quartile (p=0.001), and relationship to recipient (p<0.001), with greater proportions of forms in amnesty status for Black (Black: 19.3%;White: 15.6%;Hispanic: 13.7%;Other: 14.6%), male (male: 16.7%;female: 15.0%), younger (age 18-34: 16.9%;35-49: 16.4%;50-64: 13.9%;65+: 13.7%), lower-income (Q1: 18.3%;Q2: 15.6%;Q3: 15.9%;Q4: 14.6%), biologically related and paired donors (biologically related: 16.8%;paired: 17.6%;spousal: 12.1%;unrelated: 14.5%) (Table 1). Liver: Younger donors had greater proportions of forms in amnesty status (age 18-34: 12.9%;35-49: 10.0%;50-64: 6.4%;p=0.056). Pre-COVID demographic differences in forms with complete lab data persisted during COVID, compounded by amnesty forms (Figure 1). Conclusions: Centers have voluntarily submitted over 80% of expected LDFs under this emergency policy. However, our finding that a disproportionate number of forms are missing for donors who are Black, male, younger, lower SES, and biological relatives of their recipient is concerning. These groups are at greater risk of long-term complications after donation, and may have limited access to health services during the pandemic and risk being lost to follow-up. Centers should consider targeted follow-up efforts for at-risk groups. (Table Presented).