*Purpose: We aim to describe the trends in intestinal and multivisceral transplant waiting list activity and outcomes before and after the COVID-19 pandemic.

*Methods: We used the cohort of intestinal and multivisceral transplant candidates who were on the waiting list November 1, 2020 – June 12, 2020 as recorded in the UNOS STAR files pulled on June 12, 2020. March 1, 2020 was considered “post-COVID.” We used the INTESTINE_WLHISTORY_DATA file to evaluate the frequency of waitlist additions, modifications, and removals over time. Monthly regional Expected events were calculated using the average monthly number of events February 2019-February 2020, and compared to monthly regional Observed events during March 2020-May 2020

*Results: In the four months pre-COVID, 193 changes were made to the intestine waiting list, compared with 257 post-COVID. One center reported a dramatic increase in waiting list activity in May 2020, with high activation & inactivation of candidates. All other centers combined exhibited a decrease in intestinal transplant waitlist additions and activations post-COVID. Observed:Expected ratios (O:E) for waitlist activity and transplants stratified by intestine-only and multivisceral candidates are shown in Figure 1. Regions 6 and 7 had no recorded multivisceral waiting list additions, removals, or modifications after March 1, 2020. After March 1, 2020, most regions performed fewer transplants, with a minority increasing their monthly transplant volume. National monthly transplant rates remained stable. Figure 2. There were very few waiting list deaths, with only two recorded post-COVID.

*Conclusions: Though most regions reduced intestinal and multivisceral transplant volumes after March 1, 2020, national transplant rates remained stable demonstrating significant regional variation in COVID-19 effect on practice.

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