*Purpose: COVID-19 has drastically impacted healthcare systems since its declaration as a pandemic in March 2020. Evidence of this impact persists among solid organ transplant programs, with vast disruptions to kidney transplant reported nationwide. Little is known about the influence of COVID-19 on early transplant steps occurring at the dialysis facility level. We sought to describe the staff-reported impact of COVID-19 on kidney transplant referrals and evaluations.

*Methods: A cross-sectional survey was emailed to n=579 dialysis facility staff in ESRD Network 6 (Georgia, North Carolina, and South Carolina) in April 2020. Responses were linked to 2015-2018 Centers for Medicare and Medicaid Services Dialysis Facility Report data, and patient and facility characteristics were compared using t-tests, Wilcoxon rank-sum tests, and chi-square tests.

*Results: Among 280 survey responses received from unique dialysis facilities, 28.9% of respondents disclosed that transplant referrals were affected by COVID-19, and 60.4% described transplant evaluations as affected (Table 1). When describing barriers to quality improvement activities due to COVID-19, the most prominent concerns were “dependent institutions not operating as usual” (48.6%), an “overwhelmed healthcare system” (33.6%), and transportation issues (26.8%). Facilities were comparable with regards to patient and facility demographic, clinical, and socioeconomic characteristics.

*Conclusions: Our findings provide further evidence that kidney transplant has been substantially affected by the COVID-19 pandemic, even at the dialysis facility level. Policies surrounding transitions to normal operations among dialysis facilities in the Southeastern United States must consider the long-term implications of these delays related to transplant access.

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