Early impact of COVID-19 on transplant center practices and policies in the United States

Am J Transplant. 2020 Jul;20(7):1809-1818 doi: 10.1111/ajt.15915.
Abstract

COVID-19 is a novel, rapidly changing pandemic: consequently, evidence-based recommendations in solid organ transplantation (SOT) remain challenging and unclear. To understand the impact on transplant activity across the United States, and center-level variation in testing, clinical practice, and policies, we conducted a national survey between March 24, 2020 and March 31, 2020 and linked responses to the COVID-19 incidence map. Response rate was a very high 79.3%, reflecting a strong national priority to better understand COVID-19. Complete suspension of live donor kidney transplantation was reported by 71.8% and live donor liver by 67.7%. While complete suspension of deceased donor transplantation was less frequent, some restrictions to deceased donor kidney transplantation were reported by 84.0% and deceased donor liver by 73.3%; more stringent restrictions were associated with higher regional incidence of COVID-19. Shortage of COVID-19 tests was reported by 42.5%. Respondents reported a total of 148 COVID-19 recipients from <1 to >10 years posttransplant: 69.6% were kidney recipients, and 25.0% were critically ill. Hydroxychloroquine (HCQ) was used by 78.1% of respondents; azithromycin by 46.9%; tocilizumab by 31.3%, and remdesivir by 25.0%. There is wide heterogeneity in center-level response across the United States; ongoing national data collection, expert discussion, and clinical studies are critical to informing evidence-based practices.

Metadata
Organ: Various; Kidney; Liver; Lung; Heart; Pancreas; Intestine; Simultaneous Kidney/Pancreas; Heart/Lung
Language: English
Country: USA
MeSH terms: Adenosine Monophosphate; Alanine; Antibodies, Monoclonal, Humanized; Betacoronavirus; COVID-19; COVID-19 Testing; Clinical Laboratory Techniques; Coronavirus Infections; Critical Illness; Evidence-Based Medicine; Health Policy; Humans; Hydroxychloroquine; Incidence; Kidney Failure, Chronic; Kidney Transplantation; Liver Transplantation; Living Donors; Organ Transplantation; Pandemics; Pneumonia, Viral; Resource Allocation; SARS-CoV-2; Surveys and Questionnaires; Tissue Donors; Transplant Recipients; United States; COVID-19 Drug Treatment; Lung Transplantation; Heart Transplantation; Pancreas Transplantation; Heart-Lung Transplantation; 0 (Antibodies, Monoclonal, Humanized); 3QKI37EEHE (Remdesivir); 415SHH325A (Adenosine Monophosphate); 4QWG6N8QKH (Hydroxychloroquine); I031V2H011 (Tocilizumab); OF5P57N2ZX (Alanine); Covid-19; COVID-19 Diagnostic Testing