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Trends in US Heart Transplant Waitlist Activity and Volume During the Coronavirus Disease 2019 (COVID-19) Pandemic

Educational Objective
To understand the trends in the activity and volume of the US Heart Transplant Waitlist during COVID-19
1 Credit CME
Key Points

Question  How have heart transplant listings and volumes in the US changed during the coronavirus disease 2019 (COVID-19) pandemic?

Findings  In this cross-sectional analysis of heart transplant data from the United Network for Organ Sharing and the US Centers for Disease Control and Prevention, compared with the pre–COVID-19 era, the total number of waitlist inactivations has increased while new waitlist additions, deceased donor recoveries, and heart transplants have decreased across the US. During the COVID-19 era, there was significant regional variation in these practices.

Meaning  Further studies are needed to determine the long-term associations between these trends and waitlist and posttransplant outcomes.

Abstract

Importance  Solid organ transplants have declined significantly during the coronavirus disease (COVID-19) pandemic in the US. Limited data exist regarding changes in heart transplant (HT).

Objective  To describe national and regional trends in waitlist inactivations, waitlist additions, donor recovery, and HT volume during COVID-19.

Design, Setting, and Participants  This descriptive cross-sectional study used publicly available data from the United Network for Organ Sharing and US Centers for Disease Control and Prevention, using 8 prespecified United Network for Organ Sharing regions. Adult (18 years or older) HT candidates listed and deceased donors recovered between January 19 to May 9, 2020.

Exposures  COVID-19 pandemic.

Main Outcomes and Measures  Changes in waitlist inactivations, waitlist additions, deceased donor recovery, and transplant volumes from the pre–COVID-19 (January 19-March 15, 2020) to the COVID-19 era (March 15-May 9, 2020). Density mapping and linear regression with interrupted time series analysis were used to characterize changes over time and changes by region.

Results  During the COVID-19 era, there were 600 waitlist inactivations compared with 343 during the pre-COVID era (75% increase). Waitlist additions decreased from 637 to 395 (37% reduction). These changes were most profound in the Northeast and Great Lakes regions with high rates of COVID-19. Deceased donor recovery decreased by 26% from 1878 to 1395; the most significant decrease occurred in the North Midwest despite low COVID-19 prevalence. Heart transplant volumes were significantly reduced across all regions except the Northwest. The largest decrease was seen in the Northeast where COVID-19 case rates were highest. From the pre–COVID-19 era to the COVID-19 era, there was significant regional variation in waitlist additions (eg, 69% decrease in the Northeast vs 8.5% increase in the South Midwest; P < .001) and deceased donor recovery (eg, 41% decrease in North Midwest vs 16% decrease in South Midwest; P = .02).

Conclusions and Relevance  Heart transplant volumes have been significantly reduced in recent months, even in regions with a lower prevalence of COVID-19 cases. This has been accompanied by increased waitlist inactivations, decreased waitlist additions, and decreased donor recovery. Future studies are needed to determine if the COVID-19 pandemic is associated with changes in waitlist mortality.

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Article Information

Accepted for Publication: May 28, 2020.

Corresponding Author: Ersilia M. DeFilippis, MD, Division of Cardiology, Department of Medicine, New York–Presbyterian Hospital/Columbia University Irving Medical Center, 622 W 168th St, PH 3-347, New York, NY 10032 (ed2817@cumc.columbia.edu).

Published Online: July 22, 2020. doi:10.1001/jamacardio.2020.2696

Author Contributions: Drs DeFilippis and Sinnenberg had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs DeFilippis and Sinnenberg contributed equally as co–first authors.

Concept and design: DeFilippis, Sinnenberg, Reza, Kittleson.

Acquisition, analysis, or interpretation of data: DeFilippis, Sinnenberg, Reza, Givertz, Topkara, Farr.

Drafting of the manuscript: DeFilippis, Sinnenberg, Reza.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Sinnenberg, Reza.

Administrative, technical, or material support: Sinnenberg.

Supervision: DeFilippis, Givertz, Kittleson, Topkara, Farr.

Conflict of Interest Disclosures: None reported.

References
1.
DeFilippis  EM , Farr  MA , Givertz  MM .  Challenges in heart transplantation in the era of COVID-19.   Circulation. Published online April 21, 2020. PubMedGoogle Scholar
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Agopian  V , Verna  E , Goldberg  D .  Changes in liver transplant center practice in response to COVID-19: Unmasking dramatic center-level variability.   Liver Transpl. Published online May 5, 2020. doi:10.1002/lt.25789PubMedGoogle Scholar
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Loupy  A , Aubert  O , Reese  PP , Bastien  O , Bayer  F , Jacquelinet  C .  Organ procurement and transplantation during the COVID-19 pandemic.   Lancet. 2020;395(10237):e95-e96. doi:10.1016/S0140-6736(20)31040-0PubMedGoogle ScholarCrossref
4.
United Network for Organ Sharing. COVID-19 and solid organ transplant. Accessed April 23, 2020. https://unos.org/covid/
5.
Hall  ME , Vaduganathan  M , Khan  MS ,  et al.  Reductions in heart failure hospitalizations during the COVID-19 pandemic.   J Card Fail. Published online May, 2020. doi:10.1016/j.cardfail.2020.05.005PubMedGoogle Scholar
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