The impact of the COVID-19 pandemics on liver transplantation activity in latin american (la) countries. the latin-american (aleh) sig, international survey

ABSTRACT

Background: Regardless of the initial measures implemented by LA countries in early 2020, the COVID-19 pandemic spread rapidly and by December 31, there were 15 million confirmed cases, and 500,000 deaths. Given the overload of healthcare systems and the need for resource reallocation, a decrease in liver transplantation (LT) activity was expected in most LA countries. However, the real magnitude of this situation has not been described. The aim of this sudy is provide an overview of the impact of the pandemic on LT activity in LA countries. Methods: During 2020, LA countries were invited to nominate representatives to this special interest group (ALEH). Online meetings were arranged to fill a survey on LT activity. Some data was also obtained from the Global Observatory on Donation and Transplantation (GODT). Results: 20 LA countries participated (representing 640 million inhabitants). In 2019, there were 3,847 LT in LA, performed in 14/20 countries (total LT rate5.96 pmp) with 12% of them (n= 482) with living donors (7/20 countries) (LDLT rate0.73 pmp). In 2020, there were 2,817 LT (total LT rate4.4), with 278 LDLT (LDLT rate0.43 pmp). The pandemic was associated to a decrease of 26% in the LT rate (p < 0.01), and 41% in the LDLT rate (p<0.01). 6/20 countries not performing LT in 2019, kept no LT activity in 2020. When considering countries with LT rates > 5 ppm in 2019 (5/20), there was a decrease of 23% in the LT rate (from 10.63 to 8.16 pmp;p < 0.01) and 43% in the LDLT rate (from 1.41 to 0.79 pmp;p<0.01). When analyzing countries with a lower total LT rate (0,2-5 pmp in 2019) (9/20), there was a decrease in 62% in the total LT rate (from 1.3 to 0.45 pmp, p < 0.01) and of 21% in the LDLT rate (from 0.06 to 0.047 pmp;p NS). COVID-19 cases and deaths (raw data and rates), give biased comparisons between countries, which also depends on the strategies implemented, on the testing rates, and timing of the 1st and 2nd wave peaks Conclusion: The COVID-19 pandemic, had a major impact on LT activity in LA countries, with a 26% decrease in total LT rate (p <0.01) and a 41% decrease in LDLT rates (p < 0.01). The impact was greater in countries with more limited resources and initial lower total LT rates (decrease of 62% in 2020) as compared to countries with initial higher LT rates (decrease of 23%, p < 0,01)). This situation may be related to a longstanding tradition in LT with a more consolidated systems of donation and procurement in countries with higher LT rates. AbbreviationsPop Population;Mill Millions;Dom. Rep. Dominican Republic;LT Liver Transplantation;DDLT Deceased donor LT;LDLT Living donor LT;LT Rates per million population (pmp) COVID-19 cases (per 100.000 population).