COVID-19 pandemic 'dramatically' impacted kidney transplants in 2020
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Kidney transplant activity decreased dramatically after the initial surge of COVID-19 cases at the beginning of the pandemic, according to a study. Researchers also found discard rates increased due to a lack of a recipient.
“The COVID-19 pandemic created significant disruptions to kidney transplantation in the U.S.,” Miah T. Li, MS, of the division of nephrology in the Vagelos College of Physicians and Surgeons at Columbia University, and colleagues wrote.
The researchers investigated the impact the pandemic had on deceased donor kidney utilization and discard rates. They analyzed national registry data for 2020, paying particular attention to organ discards, transplant center utilization and patient selection. They considered the initial surge of the pandemic in the United States to be March 18 to May 12, 2020.
Transplant activity
Analyses revealed that 20% of transplant centers stopped and 42% reduced the number of deceased donor kidney transplants being performed. However, some centers maintained (n = 38, 18%) or increased (n = 44, 20%) transplant activity during the initial surge. The overall number of deceased donors dropped dramatically during the initial surge from 252 donors weekly prior to the surge to 156 donors the week of March 25, 2020. Among the deceased donors, 168 kidneys (6%) that were planned for transplantation were not procured during the initial surge and the weekly kidney discharge rate was highest during the initial surge, up to 29% at one point. Fluctuations in discharge rate coincided with different waves of infection during the pandemic, according to the researchers. Of the discards in 2020, 52% came from a failure to identify a recipient, with a peak of 60% during the initial surge in April compared with an average of 47% between January and February 2020. About one in five discards resulted from poor biopsy findings, although investigators found this decreased during the height of the initial surge.
Kidney donor profile index
Although transplant activity decreased during the pandemic in 2020, centers that continued transplants reported better estimated survival scores. Centers became more selective, and the median kidney donor profile index (KDPI) dropped up to 14% during the surge compared with rates before the pandemic. Centers that decreased or had no change in transplant activity had organs with a significantly lower KDPI during the surge. However, centers that increased transplant volume did not have a significant decrease in the KDPI of organs transplanted. Overall, an increase in KDPI followed the initial surge, but it remained consistently below levels prior to the pandemic at the end of 2020.
“Discard rates and procurement rates varied considerably across the country but were most prominently observed in [New York and western Vermont], consistent with geographic patterns of COVID-19 spread early in the pandemic. Our findings underscore the ability of centers to adjust their thresholds for which patients and organs they would consider for transplantation within the framework of the current allocation system by turning down deceased donor organ offers,” Li and colleagues wrote. “The marked increase in organ discards potentially represents hundreds of missed opportunities for transplantation and emphasizes the need to develop contingency plans that would allow the continued use of deceased donor organs in circumstances such as future pandemics.”
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