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.

中文翻译：

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COVID-19 大流行对美国小儿肾移植的影响

背景

2020 年 3 月，COVID-19 感染在美国开始呈指数增长，给医疗保健系统带来沉重负担。结果，移植实践和政策发生了迅速变化，大多数程序都停止了。我们的目标是了解 COVID-19 流行期间国家层面的小儿肾移植 (KT) 变化。

方法

使用 SRTR 数据，我们检查了与去年同期相比，美国疾病传播开始期间儿科候补名单登记、候补名单删除或灭活以及已故供体和活体供体 (DDKT/LDKT) 事件的变化。

结果

与预期事件相比，我们看到 DDKT 和 LDKT 最初分别下降了 47% 和 82%，然后持续增加，到 2020 年 5 月达到预期的大流行前水平。在大流行的早期阶段，候补名单因死亡而被停用和移除或恶化状况分别比预期值高出 152% 和 189%。在COVID 活动高与低的州，新增候补名单 (IRR _0.49 0.65 _0.85 ) 和 LDKT (IRR _0.17 0.38 _{0.84 ) 在统计上显着下降。}大流行期间的移植受者更有可能接受了 DDKT，但计算得出的面板反应性抗体 (cPRA) 值、候补时间和肾衰竭原因与大流行前相似。

结论

COVID-19 大流行最初减少了美国儿科患者接受肾移植的机会，但没有产生持续的影响。