COVID-19 pandemic and worldwide organ transplantation: a population-based study.

Olivier Aubert, Daniel Yoo, Dina Zielinski, Emanuele Cozzi, Massimo Cardillo, Michael Dürr, Beatriz Domínguez-Gil, Elisabeth Coll, Margarida Ivo Da Silva, Ville Sallinen, Karl Lemström, Karsten Midtvedt, Camilo Ulloa, Franz Immer, Annemarie Weissenbacher, Natalie Vallant, Nikolina Basic-Jukic, Kazunari Tanabe, Georgios Papatheodoridis, Georgia Menoudakou, Martin Torres, Carlos Soratti, Daniela Hansen Krogh, Carmen Lefaucheur, Gustavo Ferreira, Helio Tedesco Silva, David Hartell, John Forsythe, Lisa Mumford, Peter P Reese, François Kerbaul, Christian Jacquelinet, Serge Vogelaar, Vassilios Papalois, Alexandre Loupy

Journal: The Lancet. Public health 2021;6(10):e709-e719

PMID: 34474014

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Abstract

BACKGROUND

Preliminary data suggest that COVID-19 has reduced access to solid organ transplantation. However, the global consequences of the COVID-19 pandemic on transplantation rates and the effect on waitlisted patients have not been reported. We aimed to assess the effect of the COVID-19 pandemic on transplantation and investigate if the pandemic was associated with heterogeneous adaptation in terms of organ transplantation, with ensuing consequences for waitlisted patients.

METHODS

In this population-based, observational, before-and-after study, we collected and validated nationwide cohorts of consecutive kidney, liver, lung, and heart transplants from 22 countries. Data were collected from Jan 1 to Dec 31, 2020, along with data from the same period in 2019. The analysis was done from the onset of the 100th cumulative COVID-19 case through to Dec 31, 2020. We assessed the effect of the pandemic on the worldwide organ transplantation rate and the disparity in transplant numbers within each country. We estimated the number of waitlisted patient life-years lost due to the negative effects of the pandemic. The study is registered with ClinicalTrials.gov, NCT04416256.

FINDINGS

Transplant activity in all countries studied showed an overall decrease during the pandemic. Kidney transplantation was the most affected, followed by lung, liver, and heart. We identified three organ transplant rate patterns, as follows: 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 countries with a slight decrease in transplantation rate despite a high COVID-19-related death rate. Temporal trends revealed a marked worldwide reduction in transplant activity during the first 3 months of the pandemic, with losses stabilising after June, 2020, but decreasing again from October to December, 2020. The overall reduction in transplants during the observation time period translated to 48 239 waitlisted patient life-years lost.

INTERPRETATION

We quantified the impact of the COVID-19 pandemic on worldwide organ transplantation activity and revealed heterogeneous adaptation in terms of organ transplantation, both at national levels and within countries, with detrimental consequences for waitlisted patients. Understanding how different countries and health-care systems responded to COVID-19-related challenges could facilitate improved pandemic preparedness, notably, how to safely maintain transplant programmes, both with immediate and non-immediate life-saving potential, to prevent loss of patient life-years.

FUNDING

French national research agency (INSERM) ATIP Avenir and Fondation Bettencourt Schueller.

Address: Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France; Kidney Transplant Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.; Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France.; Transplant Immunology Unit, Department of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy; Italian National Transplant Center, Istituto Superiore di Sanità, Rome, Italy.; Italian National Transplant Center, Istituto Superiore di Sanità, Rome, Italy.; Division of Nephrology and Internal Intensive Care Medicine, Charité-Universitätsmedizin, Berlin, Germany.; Organización Nacional de Transplantes, Madrid, Spain.; Instituo portuges de sangue e da transplantacao, Lisbon, Portugal.; Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.; Department of Cardiothoracic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.; Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Nephrology Department, Clínica Alemana de Santiago-UDD, Santiago, Chile.; Swisstransplant, Bern, Switzerland.; Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria.; Department of Transplant Surgery, Faculty of Medicine, Imperial College London, London, UK.; Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia.; Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.; Hellenic Transplant Organization, Athens, Greece.; Instituto Nacional Central Único Coordinador de Ablación e Implante (INCUCAI), Buenos Aires, Argentina.; Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France; Department of Nephrology and Kidney Transplantation, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.; Department of Medicine, Santa Casa de Juiz de Fora, Juiz de Fora, Brazil.; Division of Nephrology, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil.; Canadian Blood Services, Ottawa, ON, Canada.; NHS Blood and Transplant, Stoke Gifford, Bristol, UK.; Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK.; Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France; Department of Medicine, Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.; Agence de la Biomédecine, Saint Denis la Plaine, France.; Eurotransplant International Foundation, Leiden, Netherlands.; Department of Surgery, Faculty of Medicine, Imperial College London, London, UK.; Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France; Kidney Transplant Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. Electronic address: [email protected].

DOI: 10.1016/S2468-2667(21)00200-0

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MeSH Terms: COVID-19, Global Health, Humans, Organ Transplantation, Pandemics