Organ Transplants Fell by a Third Globally During Pandemic's First Wave

By Marilynn Larkin

September 09, 2021

NEW YORK (Reuters Health) - Organ transplants fell by a third globally during the first wave of the COVID-19 pandemic, but the impact varied across countries, providing an opportunity for cross-country learning to improve future preparedness, researchers say.

"We found that some countries, such as U.S., Switzerland, Belgium and Italy, managed to sustain the rate of transplant procedures compared with the high COVID-19-related death rate, while other countries had serious reductions in the number of transplants compared with the previous year," Dr. Olivier Aubert of The Paris Translational Research Center for Organ Transplantation told Reuters Health by email.

"In the US, for example, they performed transplantations in regions with few COVID-19 cases such as California, while in France, the whole country stopped kidney transplantations during the first wave," he said. "This study shows that each country should learn from each other and based on those comparisons, international guidelines should be developed to maintain transplant programs during pandemics."

As presented at the ESOT Congress 2021 and published in The Lancet Public Health, Dr. Aubert and colleagues analyzed data from 22 countries on kidney, liver, lung and heart transplants done throughout 2020, and compared them to 2019 data.

Transplant activity in all countries studied showed an overall decrease of 15.92% during the pandemic.

The available data did not allow the research team to determine why reductions in transplant volume took place.

Kidney transplantation was most affected (-19.14%), followed by lung (-15.51%), liver (-10.57%), and heart (-5.44%).

Decreases in organ transplant activity varied according to country and organ, with three patterns: countries with a sharp decrease in transplantation rate with a low COVID-19-related death rate; countries with a moderate decrease in transplantation rate with a moderate COVID-19-related death rate; and those with a slight decrease in transplantation rate despite a high COVID-19-related death rate.

Deceased donor transplant activity decreased by 11% across all countries except Canada, where the data could not be stratified by donor type. Specifically, decreases were 11.91% for kidney; 9.33% for liver; 16.64% for lung; and 5.46% for heart.

Living donor transplants decreased by 39.52% overall, with a 40.19% decrease for kidney and 32.53% decrease for liver.

Temporal trends showed a marked worldwide reduction in transplant activity during the first three months of the pandemic, with losses stabilizing after June 2020 but decreasing again from October to December.

Modeling studies revealed that the reductions translated to 48,239 waitlisted patient life-years lost.

The authors state, "These findings should motivate improved pandemic preparedness for both life-saving procedures and those that can be postponed, but not without detriment to patient health and wellbeing."

Dr. Sham Dholakia, Chief Medical Officer at CareDx and leader of the development of the C19TxR registry for COVID tracking of transplant patients, commented in an email to Reuters Health, "At face value, 22 counties is impressive, with 72% of the countries being European. But the volume of these transplants is very variable."

"For example, the UK provides just over 3,000 kidney transplants a year versus 1,267 from Scandiatransplant, which captures data from Sweden, Norway, Finland, Iceland, Estonia and Denmark," he said. "Countries such as Japan have very limited deceased donor transplantation (and) the authors excluded the Japanese data from the temporal data, (which) makes it difficult to consider the data for the main analysis."

"At the same time, countries are held to different regulatory standards," he noted. "In broad brush strokes, this impacts the appetite for risk. The U.S. is held to a much higher bar in terms of morbidity and mortality, focused on one-year outcomes, and so was risk-adverse."

"COVID source data is based on transplant centers uploading and reporting cases," he said. "This capture was done voluntarily in most countries and so the accuracy of the capture and the overall magnitude can only be estimated, especially as testing infrastructure was lacking in many countries and was not effective until mid to late 2020. The authors acknowledge this ascertainment bias - but it's a significant factor to the model."

Further, he added, "Counting multiorgan transplants as two transplants - for example, kidney/liver counted as one liver and one kidney - can also become problematic."

"Transplantation is the risk business," Dr. Dholakia said. "The entire specialty is driven around the quantification and mitigation of risk. Sharing data, learning quickly and being able to pivot quickly is what defines success in any disaster and so having a clear protocol where the normal bureaucracy and red tape can be eliminated to allow clear and quick data sharing will better support transplant centers globally."

SOURCE: The Lancet Public Health, online August 30, 2021.