ESOT 2021: Kidney transplants plummeted by 40% during first wave of COVID-19 pandemic

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kidney transplantation covid-19The number of solid organ transplants performed during the first wave of the COVID-19 pandemic in 2020 plunged by nearly a third (31%) compared to the previous year, according to a new global study presented at the European Society for Organ Transplantation Congress (ESOT 2021; 29 August­–1 September, Milan, Italy and virtual)—with kidney transplantation specifically showing the largest reduction (40%) across nearly all countries during 2020.

The research leveraged international data from 22 countries across four continents and revealed major variations in the response of transplant programmes to the COVID-19 pandemic, with transplant activity dropping by more than 90% in some countries. According to modelling calculations, this slowdown in transplants resulted in more than 48,000 years of patient life-loss.

Kidney transplantation showed the largest reduction across nearly all countries during 2020 compared to 2019, with the study finding a 40% decrease in living donor kidney transplants and a 33% drop in liver transplants. For deceased donor transplants, there was a reduction in kidney (-12%), liver (-9%), lung (-17%) and heart (-5%) transplants.

The research, published in The Lancet Public Health, also highlights how some countries managed to sustain the rate of transplant procedures whilst others experienced serious reductions in the number of transplants compared to the previous year and, in some areas, living donor kidney and liver transplantation ceased completely. Overall, there was a strong temporal association between increased COVID-19 infection rate, and reductions in deceased and living solid organ transplants.

Olivier Aubert, assistant professor at the Paris Translational Research Center for Organ Transplantation (Paris, France) and lead author of the study, said: “The first wave of COVID-19 had a devastating impact on the number of transplants across many countries, affecting patient waiting lists and regrettably leading to a substantial loss of life.”

Alexandre Loupy, head of the Paris Translational Research Center for Organ Transplantation and last author of the study, added: “Living donor transplantation, which reduced more substantially, requires significant resources and planning compared to deceased donor transplantation. This is extremely difficult during a pandemic when resources are stretched and staff are being redeployed. There are also major ethical concerns for the wellbeing and safety of the donor.

“It is clear that there are many indirect deaths associated with COVID-19 and our study confirms that the pandemic has far-reaching consequences on many medical specialties.”

The estimated numbers of life-years lost were 37,664 years for patients waitlisted for a kidney, 7,370 for a liver, 1,799 for a lung, and 1,406 for a heart, corresponding to a total 48,239 life-years lost.

“Beyond the near-universal reduction in transplant activity, certain countries and regions managed to carry out procedures despite major challenges presented by the pandemic,” Aubert added. “These findings warrant further analysis on a regional, national and global level to understand why reductions did or did not occur.

“Understanding how different countries and healthcare systems responded to COVID-19-related challenges can facilitate improved pandemic preparedness and how to safely maintain transplant programmes to provide life-saving procedures for patients.”

To facilitate understanding of the temporal trends and consequences of the pandemic on worldwide, national, and regional solid organ transplant activities for researchers, clinicians, and public health authorities, the authors created an open-access dashboard that presents data interactively for solid organ transplant activities and COVID-19 cases—which can be viewed here.

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