Decreased access to pediatric liver transplantation during the COVID‐19 pandemic. (11th October 2021)

• Record Type: Journal Article
• Authors: Kemme, Sarah; Yoeli, Dor; Sundaram, Shikha S.; Adams, Megan A.; Feldman, Amy G.
• Is Part Of: Pediatric transplantation. Volume 26:Number 2(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-10-11
• Subjects: access to care -- COVID‐19 -- outcome -- pediatric liver transplantation; Transplantation of organs, tissues, etc. in children -- Periodicals; 617.95408305
• DOI: 10.1111/petr.14162
• Languages: English
• ISSNs: 1397-3142

Abstract

Abstract: Background: The COVID‐19 pandemic has affected all aspects of the US healthcare system, including liver transplantation. The objective of this study was to understand national changes to pediatric liver transplantation during COVID‐19. Methods: Using SRTR data, we compared waitlist additions, removals, and liver transplantations for pre‐COVID‐19 (March‐November 2016–2019), early COVID‐19 (March‐May 2020), and late COVID‐19 (June‐November 2020). Results: Waitlist additions decreased by 25% during early COVID‐19 (41.3/month vs. 55.4/month, p < .001) with black candidates most affected ( p = .04). Children spent longer on the waitlist during early COVID‐19 compared to pre‐COVID‐19 (140 vs. 96 days, p < .001). There was a 38% decrease in liver transplantations during early COVID‐19 (IRR 0.62, 95% CI 0.49–0.78), recovering to pre‐pandemic rates during late COVID‐19 (IRR 1.03, NS), and no change in percentage of living and deceased donors. White children had a 30% decrease in overall liver transplantation but no change in living donor liver transplantation (IRR 0.7, 95% CI 0.50–0.95; IRR 0.96, NS), while non‐white children had a 44% decrease in overall liver transplantation (IRR 0.56, 95% CI 0.40–0.77) and 81% decrease in living donor liver transplantation (IRR 0.19, 95% CI 0.02–0.76). Conclusions: The COVID‐19 pandemic decreased access to pediatric liver transplantation, particularly in its early stage. There were no regional differences in liver transplantation during COVID‐19 despite the increased national sharing of organs. While pediatric liver transplantation has resumed pre‐pandemic levels, ongoing racial disparities must be addressed.