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. Epub 2020 May 10.

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.

Keywords: clinical decision-making; epidemiology; guidelines; infectious agents-viral.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenosine Monophosphate / analogs & derivatives
  • Adenosine Monophosphate / therapeutic use
  • Alanine / analogs & derivatives
  • Alanine / therapeutic use
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Betacoronavirus
  • COVID-19
  • COVID-19 Testing
  • Clinical Laboratory Techniques / statistics & numerical data
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / prevention & control*
  • Coronavirus Infections / transmission*
  • Critical Illness
  • Evidence-Based Medicine
  • Health Policy
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Incidence
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation / statistics & numerical data
  • Kidney Transplantation / trends
  • Liver Transplantation / statistics & numerical data
  • Liver Transplantation / trends
  • Living Donors
  • Organ Transplantation / legislation & jurisprudence
  • Organ Transplantation / statistics & numerical data
  • Organ Transplantation / trends*
  • Pandemics / prevention & control*
  • Pneumonia, Viral / prevention & control*
  • Pneumonia, Viral / transmission*
  • Resource Allocation
  • SARS-CoV-2
  • Surveys and Questionnaires
  • Tissue Donors
  • Transplant Recipients
  • United States

Substances

  • Antibodies, Monoclonal, Humanized
  • remdesivir
  • Adenosine Monophosphate
  • Hydroxychloroquine
  • tocilizumab
  • Alanine

Supplementary concepts

  • COVID-19 drug treatment