Decreased access to pediatric liver transplantation during the COVID-19 pandemic

Pediatr Transplant. 2022 Mar;26(2):e14162. doi: 10.1111/petr.14162. Epub 2021 Oct 11.


Background: The COVID-19 pandemic has affected all aspects of the US healthcare system, including liver transplantation. The objective of this study was to understand national changes to pediatric liver transplantation during COVID-19.

Methods: Using SRTR data, we compared waitlist additions, removals, and liver transplantations for pre-COVID-19 (March-November 2016-2019), early COVID-19 (March-May 2020), and late COVID-19 (June-November 2020).

Results: Waitlist additions decreased by 25% during early COVID-19 (41.3/month vs. 55.4/month, p < .001) with black candidates most affected (p = .04). Children spent longer on the waitlist during early COVID-19 compared to pre-COVID-19 (140 vs. 96 days, p < .001). There was a 38% decrease in liver transplantations during early COVID-19 (IRR 0.62, 95% CI 0.49-0.78), recovering to pre-pandemic rates during late COVID-19 (IRR 1.03, NS), and no change in percentage of living and deceased donors. White children had a 30% decrease in overall liver transplantation but no change in living donor liver transplantation (IRR 0.7, 95% CI 0.50-0.95; IRR 0.96, NS), while non-white children had a 44% decrease in overall liver transplantation (IRR 0.56, 95% CI 0.40-0.77) and 81% decrease in living donor liver transplantation (IRR 0.19, 95% CI 0.02-0.76).

Conclusions: The COVID-19 pandemic decreased access to pediatric liver transplantation, particularly in its early stage. There were no regional differences in liver transplantation during COVID-19 despite the increased national sharing of organs. While pediatric liver transplantation has resumed pre-pandemic levels, ongoing racial disparities must be addressed.

Keywords: COVID-19; access to care; outcome; pediatric liver transplantation.

MeSH terms

  • Adolescent
  • COVID-19*
  • Child
  • Child, Preschool
  • Female
  • Health Services Accessibility / trends*
  • Healthcare Disparities / ethnology
  • Healthcare Disparities / trends*
  • Humans
  • Infant
  • Infant, Newborn
  • Liver Transplantation / trends*
  • Living Donors / statistics & numerical data
  • Male
  • Registries
  • Retrospective Studies
  • United States
  • Waiting Lists / mortality*