Ersilia M DeFilippis1, Lauren Sinnenberg2, Nosheen Reza3, Michael M Givertz2, Michelle M Kittleson4, Veli K Topkara1, Maryjane A Farr1. 1. Division of Cardiology, Columbia University Irving Medical Center, New York, New York. 2. Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 3. Perelman School of Medicine, Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia. 4. Smidt Heart Institute, Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California.
Abstract
IMPORTANCE: Solid organ transplants have declined significantly during the coronavirus disease (COVID-19) pandemic in the US. Limited data exist regarding changes in heart transplant (HT). OBJECTIVE: To describe national and regional trends in waitlist inactivations, waitlist additions, donor recovery, and HT volume during COVID-19. DESIGN, SETTING, AND PARTICIPANTS: This descriptive cross-sectional study used publicly available data from the United Network for Organ Sharing and US Centers for Disease Control and Prevention, using 8 prespecified United Network for Organ Sharing regions. Adult (18 years or older) HT candidates listed and deceased donors recovered between January 19 to May 9, 2020. EXPOSURES: COVID-19 pandemic. MAIN OUTCOMES AND MEASURES: Changes in waitlist inactivations, waitlist additions, deceased donor recovery, and transplant volumes from the pre-COVID-19 (January 19-March 15, 2020) to the COVID-19 era (March 15-May 9, 2020). Density mapping and linear regression with interrupted time series analysis were used to characterize changes over time and changes by region. RESULTS: During the COVID-19 era, there were 600 waitlist inactivations compared with 343 during the pre-COVID era (75% increase). Waitlist additions decreased from 637 to 395 (37% reduction). These changes were most profound in the Northeast and Great Lakes regions with high rates of COVID-19. Deceased donor recovery decreased by 26% from 1878 to 1395; the most significant decrease occurred in the North Midwest despite low COVID-19 prevalence. Heart transplant volumes were significantly reduced across all regions except the Northwest. The largest decrease was seen in the Northeast where COVID-19 case rates were highest. From the pre-COVID-19 era to the COVID-19 era, there was significant regional variation in waitlist additions (eg, 69% decrease in the Northeast vs 8.5% increase in the South Midwest; P < .001) and deceased donor recovery (eg, 41% decrease in North Midwest vs 16% decrease in South Midwest; P = .02). CONCLUSIONS AND RELEVANCE: Heart transplant volumes have been significantly reduced in recent months, even in regions with a lower prevalence of COVID-19 cases. This has been accompanied by increased waitlist inactivations, decreased waitlist additions, and decreased donor recovery. Future studies are needed to determine if the COVID-19 pandemic is associated with changes in waitlist mortality.
IMPORTANCE: Solid organ transplants have declined significantly during the coronavirus disease (COVID-19) pandemic in the US. Limited data exist regarding changes in heart transplant (HT). OBJECTIVE: To describe national and regional trends in waitlist inactivations, waitlist additions, donor recovery, and HT volume during COVID-19. DESIGN, SETTING, AND PARTICIPANTS: This descriptive cross-sectional study used publicly available data from the United Network for Organ Sharing and US Centers for Disease Control and Prevention, using 8 prespecified United Network for Organ Sharing regions. Adult (18 years or older) HT candidates listed and deceased donors recovered between January 19 to May 9, 2020. EXPOSURES: COVID-19 pandemic. MAIN OUTCOMES AND MEASURES: Changes in waitlist inactivations, waitlist additions, deceased donor recovery, and transplant volumes from the pre-COVID-19 (January 19-March 15, 2020) to the COVID-19 era (March 15-May 9, 2020). Density mapping and linear regression with interrupted time series analysis were used to characterize changes over time and changes by region. RESULTS: During the COVID-19 era, there were 600 waitlist inactivations compared with 343 during the pre-COVID era (75% increase). Waitlist additions decreased from 637 to 395 (37% reduction). These changes were most profound in the Northeast and Great Lakes regions with high rates of COVID-19. Deceased donor recovery decreased by 26% from 1878 to 1395; the most significant decrease occurred in the North Midwest despite low COVID-19 prevalence. Heart transplant volumes were significantly reduced across all regions except the Northwest. The largest decrease was seen in the Northeast where COVID-19 case rates were highest. From the pre-COVID-19 era to the COVID-19 era, there was significant regional variation in waitlist additions (eg, 69% decrease in the Northeast vs 8.5% increase in the South Midwest; P < .001) and deceased donor recovery (eg, 41% decrease in North Midwest vs 16% decrease in South Midwest; P = .02). CONCLUSIONS AND RELEVANCE: Heart transplant volumes have been significantly reduced in recent months, even in regions with a lower prevalence of COVID-19 cases. This has been accompanied by increased waitlist inactivations, decreased waitlist additions, and decreased donor recovery. Future studies are needed to determine if the COVID-19 pandemic is associated with changes in waitlist mortality.
Authors: Michael E Hall; Muthiah Vaduganathan; Muhammad Shahzeb Khan; Lampros Papadimitriou; Robert C Long; Gabriel A Hernandez; Charles K Moore; Brandon W Lennep; Michael R McMullan; Javed Butler Journal: J Card Fail Date: 2020-05-13 Impact factor: 5.712
Authors: Danielle S Burstein; Joseph W Rossano; JoAnn Lindenfeld; Kelly H Schlendorf; Nhue Do; Justin Godown; Matthew J O'Connor; Katsuhide Maeda; Jonathan B Edelson; Kimberly Y Lin; Jeremy A Mazurek; Shelley R Scholl; Jonathan N Menachem Journal: JAMA Cardiol Date: 2022-09-21 Impact factor: 30.154
Authors: Mohamed O Mohamed; Nick Curzen; Mark de Belder; Andrew T Goodwin; James C Spratt; Lognathen Balacumaraswami; John Deanfield; Glen P Martin; Muhammad Rashid; Ahmad Shoaib; Chris P Gale; Tim Kinnaird; Mamas A Mamas Journal: Catheter Cardiovasc Interv Date: 2021-03-25 Impact factor: 2.585
Authors: Aaron M Delman; Kevin M Turner; Courtney R Jones; Dennis M Vaysburg; Latifa S Silski; Corey King; Keith Luckett; Kamran Safdar; Ralph C Quillin; Shimul A Shah Journal: Surgery Date: 2021-01-13 Impact factor: 3.982
Authors: Luke Benvenuto; Mark E Snyder; Meghan Aversa; Shreena Patel; Joseph Costa; Lori Shah; Hilary Robbins; Frank D'Ovidio; Joshua Sonett; Bryan P Stanifer; Philippe Lemaitre; Selim Arcasoy; Michaela R Anderson Journal: Transplantation Date: 2021-04-01 Impact factor: 5.385
Authors: Gillian Hardman; Ruth Sutcliffe; Rachel Hogg; Lisa Mumford; Laura Grocott; Lorraine Jerrett; Sarah-Jane Mead-Regan; Jane Nuttall; Stephanie Dunn; Philip Seeley; Richard Quigley; Johnathan R Dalzell; Nawwar Al-Attar; Jayan Parameshwar; Andrew J Fisher; Karen Booth; John H Dark Journal: Clin Transplant Date: 2021-03-09 Impact factor: 3.456