Impact of coronavirus 2019 on pediatric and adult heart transplantation waitlist activity and mortality in the United States

ABSTRACT

Introduction: Transplant centers saw a reduction in solid organ transplantation since the beginning of the coronavirus 2019 (COVID-19) pandemic in the United States. Limited data exists on the impact of COVID-19 on pediatric heart transplant volume and variation in transplant practices. We hypothesized that pediatric heart transplant activity decreased during COVID-19 with associated increased waitlist mortality. Methods: The United Network for Organ Sharing (UNOS) database was used to identify waitlisted patients from 2017-2020. Regional and Statewide data was obtained from US Census Bureau. CovidActNow project was used for Covid-19 mortality rates. Results: Among pediatric patients, average time on the waiting list decreased by 28 days. Even though the average number of pediatric transplants (n=39) did not change during 2020, there was a temporal decline in the first quarter followed by an increase. Overall pediatric waitlist mortality decreased from 5.31 to 4.73, however female mortality increased by 2%. Regional differences in pediatric mortality included Northeast, decreased by 7.5%;Midwest, decreased by 9%;West, increased by 3.5%;and South, increased by 13%. North Dakota (0.55), Oklahoma (0.21) and Hawaii (0.33) showed higher mortality per 100,000 than other states. In adults, average time on waiting list increased by 40 days and there was an increase in the number of transplants from 242.06 to 266.09. Adult waitlist mortality had a larger decrease from 18.44 to 15.70 with increase in female mortality of 7%. Regional differences in adult mortality included Northeast, decreased by 3%;Midwest, increased by 5.5%;West, increased by 4.5% and South, decreased by 5%. Iowa (0.37), Wyoming (0.22), Arkansas (0.18) and Vermont (0.19) had higher mortality per 100,000 than other states . Conclusions: Pediatric heart transplant volume declined in early 2020 followed by an increase, while transplant volume in adults increased. Although, overall waitlist mortality for pediatrics decreased, female waitlist mortality increased. Regional differences in waitlist mortality were also observed. Future studies are needed to understand this initial correlation and to determine the impact of COVID-9 on heart transplant recipients.