A Population-Based Analysis of the Impact of the COVID-19 Pandemic on Solid Organ Transplantation in Ontario, Canada: Policy Response and Changes in Volume and 90-Day Outcomes

David Gomez; Therese A Stukel; Nancy N Baxter; Sergio A Acuna; Andrew S Wilton; Darin Treleaven; Michael Ordon; S Joseph Kim

doi:10.1097/AS9.0000000000000230

A Population-Based Analysis of the Impact of the COVID-19 Pandemic on Solid Organ Transplantation in Ontario, Canada: Policy Response and Changes in Volume and 90-Day Outcomes

Ann Surg Open. 2023 Jan 5;4(1):e230. doi: 10.1097/AS9.0000000000000230. eCollection 2023 Mar.

Authors

David Gomez^{1

2

3

4}, Therese A Stukel^{3

4}, Nancy N Baxter^{1

3

4

5}, Sergio A Acuna¹, Andrew S Wilton³, Darin Treleaven^{6

7}, Michael Ordon^{1

2

3}, S Joseph Kim^{3

4

8}

Affiliations

¹ From the Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
² Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
³ ICES, Toronto, ON, Canada.
⁴ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁵ Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
⁶ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁷ Trillium Gift of Life Network, Ontario Health, Toronto, ON, Canada.
⁸ Department of Medicine, University of Toronto and the Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.

Abstract

Objectives: To evaluate the impact of the COVID-19 pandemic on solid organ transplantation.

Background: COVID-19 caused unprecedented disruption to solid organ transplantation (kidney, liver, heart, lung). Concerns about safety and decreases in deceased donors due to pandemic lockdowns have been described as potential causes.

Methods: We report population-based rates of transplantation during the first 3 waves of COVID-19 in Ontario, Canada (March 1, 2020-July 3, 2021) versus a pre-COVID-19 baseline period (January 1, 2017-February 29, 2020). Poisson models were used to predict transplantation rates during COVID-19, based on pre-COVID-19 rates, and generate observed to expected rate ratios (RRs). Ninety-day transplant outcomes (mortality, retransplantation, transplant nephrectomy) were captured.

Results: A 34.4% decrease (RR, 0.656; 95% confidence interval [CI], 0.586-0.734) in transplant rates was observed, coinciding with wave 1 and the deployment of a provincial transplant triaging system. Transplants decreased by 14.6% in wave 2 (RR, 0.854; 95% CI, 0.770-0.947) and 23.1% in wave 3 (RR, 0.769; 95% CI, 0.690-0.857) despite the triaging system not being activated. Overall, there was a 24.3% decrease (RR, 0.757; 95% CI, 0.679-0.844) in transplant rates, equivalent to 409 fewer transplants. No sustained changes were observed in heart or liver but sustained and large decreases were seen for lung (RR, 0.664; 95% CI, 0.482-0.915) and kidney (RR, 0.721; 95% CI, 0.602-0.863) transplantation. A low prevalence (1.7%) of COVID-19 infection within 90 days of transplantation was seen. No differences were observed in other 90-day outcomes.

Conclusions: Early safety concerns limited transplantation to immediate life-saving procedures; however, the reductions in kidney and lung transplants continued for the rest of the pandemic, where no restrictions were in place.

Keywords: COVID-19; heart transplant; kidney transplant; liver transplant; lung transplant; solid organ transplantation.