The Impact of the Covid-19 Pandemic on Measures of Transplant Activity is Higher in Lower-Income Countries: A Multinational Survey Study

S. Sandal¹, B. Boyarsky², P. Chiang², A. Massie², D. Segev², M. Cantarovich¹

¹McGill University, Montreal, QC, Canada, ²Johns Hopkins University, Baltimore, MD

Meeting: 2021 American Transplant Congress

Abstract number: 311

Keywords: Multicenter studies, Resource utilization

Topic: Clinical Science » Organ Inclusive » Non-Organ Specific: Disparities to Outcome and Access to Healthcare

Session Information

Session Name: Disparities in Access and Machine Learning Outcomes in Solid Organ Transplantation

Session Type: Rapid Fire Oral Abstract

Date: Tuesday, June 8, 2021

Session Time: 4:30pm-5:30pm

Presentation Time: 4:40pm-4:45pm

Location: Virtual

*Purpose: The COVID-19 pandemic has affected the field of solid organ transplantation due to the “ramp-down” of activity during the initial months. Impact on transplant activity may vary by baseline health system vulnerabilities. We aimed to analyze this by a country’s cumulative COVID-19 incidence (CCI) and income-level.

*Methods: From June-September 2020, we conducted a multinational survey of transplant physicians. Of 1,267 physicians contacted, 40.5% from 71 countries participated. Income-level was assigned as per the World Bank Classification. CCI was calculated in person per million population (ppm) from March-July and divide into tertiles for the entire cohort (low: <2031ppm, medium: 2032-5400ppm, high: >5400ppm). Logistic regression was used to conduct a comparative analysis.

*Results: Overall, 75.2% of the programs reported a ramp-down phase, 76.8% performed transplants during this time, 69.6% reported fewer deceased donor offers, and 59.6% anticipate transplant volumes will be <75% of the norm in 2020. Compared with low/lower-middle income countries, transplant programs from high-income countries had 69% lower odds of a ramp-down phase and 50% lower odds of reporting fewer deceased donor offers. Also high income countries had higher odds of performing at least one transplant (OR=3.19, 95%CI: 1.55-6.60, p=0.002) and maintaining transplant volumes >75% (OR= 2.34, 95%CI: 1.20-4.58, p=0.01). CCI was not associated with any of these outcomes except fewer deceased donor offers in programs with moderate CCI. As shown in Table 1, kidney/pancreas transplant programs may be disproportionately affected during the pandemic.

*Conclusions: We report transplantation has incurred substantial collateral damage from the COVID-19 pandemic and measures of transplant activity during the initial months were significantly associated with the income-level of the country independent of the COVID-19 burden. It will take global effort from transplant leadership to rebuild disrupted transplant services, in particular in, countries that already have vulnerable health systems.

To cite this abstract in AMA style:

Sandal S, Boyarsky B, Chiang P, Massie A, Segev D, Cantarovich M. The Impact of the Covid-19 Pandemic on Measures of Transplant Activity is Higher in Lower-Income Countries: A Multinational Survey Study [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/the-impact-of-the-covid-19-pandemic-on-measures-of-transplant-activity-is-higher-in-lower-income-countries-a-multinational-survey-study/. Accessed May 16, 2025.

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