Effects of COVID-19 pandemic on pediatric kidney transplant in the United States
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ORIGINAL ARTICLE
Effects of COVID-19 pandemic on pediatric kidney transplant in the United States Olga Charnaya 1 & Teresa Po-Yu Chiang 2 & Richard Wang 3 & Jennifer D. Motter 2 & Brian J. Boyarsky 2 & Elizabeth A. King 2 & William A. Werbel 3 & Christine M. Durand 3 & Robin K. Avery 3 & Dorry L. Segev 2,4,5 & Allan B. Massie 2,4 & Jacqueline M. Garonzik-Wang 2 Received: 1 September 2020 / Accepted: 7 September 2020 # IPNA 2020
Abstract Background In March 2020, COVID-19 infections began to rise exponentially in the USA, placing substantial burden on the healthcare system. As a result, there was a rapid change in transplant practices and policies, with cessation of most procedures. Our goal was to understand changes to pediatric kidney transplantation (KT) at the national level during the COVID-19 epidemic. Methods Using SRTR data, we examined changes in pediatric waitlist registration, waitlist removal or inactivation, and deceased donor and living donor (DDKT/LDKT) events during the start of the disease transmission in the USA compared with the same time the previous year. Results We saw an initial decrease in DDKT and LDKT by 47% and 82% compared with expected events and then a continual increase, with numbers reaching expected prepandemic levels by May 2020. In the early phase of the pandemic, waitlist inactivation and removals due to death or deteriorating condition rose above expected values by 152% and 189%, respectively. There was a statistically significant decrease in new waitlist additions (IRR 0.49 0.65 0.85) and LDKT (IRR 0.17 0.38 0.84) in states with high vs. low COVID activity. Transplant recipients during the pandemic were more likely to have received a DDKT, but had similar calculated panel–reactive antibody (cPRA) values, waitlist time, and cause of kidney failure as before the pandemic. Conclusions The COVID-19 pandemic initially reduced access to kidney transplantation among pediatric patients in the USA but has not had a sustained effect. Keywords Kidney transplantation . Registry analysis . Pediatrics . Donation . Infectious agents-viral
Abbreviations COVID-19 Coronavirus disease 2020 KT Kidney transplant LDKT Live donor kidney transplantation
* Olga Charnaya [email protected]
DDKT CKD 5 SRTR OPTN PMP DCD IRR ICU OR
Deceased donor transplantation Stage 5 chronic kidney disease Scientific Registry of Transplant Recipients Organ Procurement and Transplantation Network Per million population Donation after circulatory death Incidence rate ratio Intensive care unit Operating room
1
Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N Wolfe St., Room 3055, Baltimore, MD 21287, USA
2
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Introduction
3
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
4
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
5
Scientific Registry of Transplant Recipients, Minneapolis, MN, USA
As the death toll from COVID-19 i
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