Heart Transplant Activity in France during the COVID-19 Outbreak

PURPOSE: The COVID-19 pandemic has deeply affected organ transplant activity across the world. During the first and second epidemic waves, the Agence de la biomedecine in agreement with the French scientific societies has pursued the heart transplant program where transplant's capacity was ensured. This study aimed to examine the impact of COVID-19 on new listings, waitlist outcomes and transplant activity in France. METHODS: All patients newly registered on the national waiting list for heart transplantation between January and September 2018-2020 were included in the study (n=1 311). The number of new listings and transplants per million population (pmp) in 2018-2019 period and in 2020 COVID era were compared. Cumulative incidence of transplantation and waitlist mortality estimated with the competing risk analysis with transplantation and death or delisting for medical condition as the competing events were compared between the study periods. RESULTS: In 2020 compared with the 2018-2019 period, the total number of patients newly registered on the waiting list declined 11%, from 6.8 to 5.9 pmp and the number of transplants performed decreased 22%, from 4.6 to 3.5 pmp. While 3-month cumulative incidence of transplantation (Figure 1) decreased from 51% [47-54] to 45% [40-50], a non-significant increase in cumulative incidence of death or delisting for medical condition (9% [7-11] versus 12% [9-15]) (Figure 2) was observed. CONCLUSION: In 2020 COVID era, the waitlist and transplant access significantly declined in France without significant change in waitlist mortality.