Early National and Center-level Changes to Kidney Transplantation in the United States During COVID-19 Epidemic.

In March 2020, COVID-19 spread rapidly nationally, causing widespread emergent changes to the health system. Our goal was to understand the impact of the epidemic on kidney transplantation (KT), at both the national and center-levels, accounting statistically for waitlist composition. Using SRTR data, we compared data on observed waitlist registrations, waitlist mortality, living-donor and deceased-donor kidney transplants (LDKT/DDKT) March 15-April 30, 2020 to expected events calculated from pre-epidemic data January 2016-February 2020. There were few changes before March 15, at which point the number of new listings/DDKT/LDKT dropped to 18%/24%/87% below the expected value (all p<0.001). Only 12 centers performed LDKT March 15-31; by April 30, 40 centers had resumed LDKT. The decline in new listings and DDKT was greater among states with higher per capita confirmed COVID-19 cases. The number of waitlist deaths was 2.2-fold higher than expected in the five states with highest COVID-19 burden (p<0.001). DCD DDKT and regional/national imports declined nationwide, but most steeply in states with the highest COVID-19 burden. The COVID-19 epidemic has resulted in substantial changes to KT; we must adapt and learn rapidly to continue provide safe access to transplantation and limit the growing indirect toll of an already deadly disease.