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.