Liver transplantation in the United States during the COVID-19 pandemic: National and center-level responses

COVID-19 has profoundly affected the American health care system; its effect on the liver transplant (LT) waitlist based on COVID-19 incidence has not been characterized. Using SRTR data, we compared observed LT waitlist registrations, waitlist mortality, deceased donor LTs (DDLT), and living donor LTs (LDLT) 3/15/2020-8/31/2020 to expected values based on historical trends 1/2016-1/2020, stratified by statewide COVID-19 incidence. Overall, from 3/15 to 4/30, new listings were 11% fewer than expected (IRR = _0.84 0.89_0.93 ), LDLTs were 49% fewer (IRR = _0.37 0.51_0.72 ), and DDLTs were 9% fewer (IRR = _0.85 0.91_0.97 ). In May, new listings were 21% fewer (IRR = _0.74 0.79_0.84 ), LDLTs were 42% fewer (IRR = _0.39 0.58_0.85 ) and DDLTs were 13% more (IRR = _1.07 1.15_1.23 ). Centers in states with the highest incidence 3/15-4/30 had 59% more waitlist deaths (IRR = _1.09 1.59_2.32 ) and 34% fewer DDLTs (IRR = _0.50 0.66_0.86 ). By August, waitlist outcomes were occurring at expected rates, except for DDLT (13% more across all incidences). While the early COVID-affected states endured major transplant practice changes, later in the pandemic the newly COVID-affected areas were not impacted to the same extent. These results speak to the adaptability of the transplant community in addressing the pandemic and applying new knowledge to patient care.