Exacerbation of Racial Disparities in Living Donor Kidney Transplant During the Covid-19 Pandemic

ABSTRACT

Purpose: The SARS-CoV-2 or coronavirus disease 2019 (COVID-19) pandemic has disproportionately impacted racial and ethnic minority groups in the United States. Although, kidney transplant procedures decreased following onset of the pandemic, the differential impact of the pandemic on racial and ethnic minority groups remains unknown. Method(s) We examined kidney-alone procedures captured in the national Scientific Registry of Transplant Recipients (SRTR) analytic files and compared the change in deceased donor kidney transplant (DDKT) and living donor kidney transplant (LDKT) pre- and post- pandemic and the associated factors. Result(s) We found that the counts of LDKT declined more for Black patients in the 12 months following onset of the pandemic, March 2020 to Feb 2021, compared with counts in the same period in the preceding 12 months. LDKT counts among Black patients fell by 42.6% compared with 33.3% in White patients (P=0.02). This pattern of decrease in LDKT counts among Black patients occurred in all geographic areas of the country (based on current UNOS COVID-19 reporting) except for the Northeast and South Midwest (Figure 1). Along with recipient race, other factors associated with a significant decline in LDKT counts included public insurance, Black living donor race, and location of residence. In contrast, DDKT counts for both Black and White candidates declined initially (10% vs. 5.9% lower respectively, P=0.11) during the pandemic and then recovered closer to pre-pandemic levels. Conclusion(s) The COVID-19 pandemic disproportionately impacted Black patients' access to LDKT. While the current rate of DDKT procedures has recovered in 2021, it is unclear whether LDKT rates will recover to parity. As locoregional surge conditions can have differential effects, ongoing attention to transplant disparities resulting from the pandemic, with appropriately targeted interventions, is warranted.