Survey of US Living Kidney Donation and Transplantation Practices in the COVID-19 Era

Krista L Lentine; Luke S Vest; Mark A Schnitzler; Roslyn B Mannon; Vineeta Kumar; Mona D Doshi; Matthew Cooper; Didier A Mandelbrot; Meera N Harhay; Michelle A Josephson; Yasar Caliskan; Asif Sharfuddin; Bertram L Kasiske; David A Axelrod

doi:10.1016/j.ekir.2020.08.017

Survey of US Living Kidney Donation and Transplantation Practices in the COVID-19 Era

Kidney Int Rep. 2020 Nov;5(11):1894-1905. doi: 10.1016/j.ekir.2020.08.017. Epub 2020 Aug 25.

Authors

Affiliations

¹ Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA.
² Department of Medicine, University of Nebraska, Omaha, Nebraska, USA.
³ University of Alabama Comprehensive Transplant Center, Birmingham, Alabama, USA.
⁴ Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.
⁵ Medstar Georgetown Transplant Institute, Washington, DC, USA.
⁶ Comprehensive Transplant Program, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA.
⁷ Department of Medicine, Drexel University, Philadelphia, Pennsylvania, USA.
⁸ Department of Medicine, University of Chicago, Chicago, Illinois, USA.
⁹ Department of Medicine, Indiana University, Indianapolis, Indiana, USA.
¹⁰ Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
¹¹ Organ Transplant Center, University of Iowa, Iowa City, Iowa, USA.

Abstract

Introduction: The scope of the impact of the coronavirus disease 2019 (COVID-19) pandemic on living donor kidney transplantation (LDKT) practices is not well defined.

Methods: We surveyed US transplant programs to assess practices, strategies, and barriers to living LDKT during the COVID-19 pandemic. After institutional review board approval, the survey was distributed from 9 May 2020 to 30 May 2020 by e-mail and postings to professional society list-servs. Responses were stratified based on state COVID-19 cumulative incidence levels.

Results: Staff at 118 unique centers responded, representing 61% of US living donor recovery programs and 75% of LKDT volume in the prepandemic year. Overall, 66% reported that LDKT surgery was on hold (81% in "high" vs. 49% in "low" COVID-19 cumulative incidence states). A total of 36% reported that evaluation of new donor candidates had paused, 27% reported that evaluations were very much decreased (>0% to <25% typical), and 23% reported that evaluations were moderately decreased (25% to <50% typical). Barriers to LDKT surgery included program concerns for donor (85%) and recipient (75%) safety, patient concerns (56%), elective case restrictions (47%), and hospital administrative restrictions (48%). Programs with higher local COVID-19 cumulative incidence reported more barriers related to staff and resource diversion. Most centers continuing donor evaluations used remote strategies (video, 82%; telephone, 43%). As LDKT resumes, all programs will screen for COVID-19, although timeframe and modalities will vary. Recommendations for presurgical self-quarantine are also variable.

Conclusion: The COVID-19 pandemic has had broad impacts on LDKT practice. Ongoing research and consensus building are needed to reduce barriers, to guide optimal practices, and to support safe restoration of LDKT across centers.

Keywords: COVID-19; kidney transplantation; living kidney donation; pandemic; screening; telehealth.

Abstract

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