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

• Published in: American Journal of Transplantation 2020-07, Vol.20 (7), p.1809-1818
• Main Authors: Boyarsky, Brian J., Po‐Yu Chiang, Teresa, Werbel, William A., Durand, Christine M., Avery, Robin K., Getsin, Samantha N., Jackson, Kyle R., Kernodle, Amber B., Van Pilsum Rasmussen, Sarah E., Massie, Allan B., Segev, Dorry L., Garonzik‐Wang, Jacqueline M.
• Format: Article
• Language: English
• Subjects: Adenosine Monophosphate - analogs & derivatives; Adenosine Monophosphate - therapeutic use; Alanine - analogs & derivatives; Alanine - therapeutic use; Antibiotics; Antibodies, Monoclonal, Humanized - therapeutic use; Antiviral drugs; Azithromycin; Betacoronavirus; Clinical decision making; Clinical Laboratory Techniques - statistics & numerical data; Coronavirus Infections - diagnosis; Coronavirus Infections - drug therapy; Coronavirus Infections - prevention & control; Coronavirus Infections - transmission; COVID-19; COVID-19 Drug Treatment; COVID-19 Testing; Critical Illness; Epidemiology; Evidence-Based Medicine; guidelines; Health Policy; Humans; Hydroxychloroquine; Hydroxychloroquine - therapeutic use; Incidence; infectious agents—viral; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - surgery; Kidney transplantation; Kidney Transplantation - statistics & numerical data; Kidney Transplantation - trends; Liver Transplantation - statistics & numerical data; Liver Transplantation - trends; Living Donors; Monoclonal antibodies; Organ Transplantation - legislation & jurisprudence; Organ Transplantation - statistics & numerical data; Organ Transplantation - trends; Original; ORIGINAL ARTICLES; Pandemics; Pandemics - prevention & control; Pneumonia, Viral - prevention & control; Pneumonia, Viral - transmission; Resource Allocation; SARS-CoV-2; Surveys and Questionnaires; Tissue Donors; Transplant Recipients; Transplants & implants; United States
• ISSN: 1600-6135; 1600-6143; 1600-6143
• DOI: 10.1111/ajt.15915

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 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. In this national survey of transplant centers during the COVID‐19 pandemic, the authors report substantial reduction in transplant activity, wide variation in COVID‐19 testing practices, and use of off‐label or investigational therapies in the treatment of 148 COVID‐19‐SOT recipients.