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A population-based analysis of the impact of the COVID-19 pandemic on solid organ transplantation in Ontario, Canada: policy response and changes in volume and 90-day outcomes


Objectives — To evaluate the impact of the COVID-19 pandemic on solid organ transplantation.

Background — COVID-19 caused unprecedented disruption to solid organ transplantation (kidney, liver, heart, lung). Concerns about safety and decreases in deceased donors due to pandemic lockdowns have been described as potential causes.

Methods — We report population-based rates of transplantation during the first 3 waves of COVID-19 in Ontario, Canada (March 1, 2020–July 3, 2021) versus a pre-COVID-19 baseline period (January 1, 2017–February 29, 2020). Poisson models were used to predict transplantation rates during COVID-19, based on pre-COVID-19 rates, and generate observed to expected rate ratios (RRs). Ninety-day transplant outcomes (mortality, retransplantation, transplant nephrectomy) were captured.

Results — A 34.4% decrease (RR, 0.656; 95% confidence interval [CI], 0.586–0.734) in transplant rates was observed, coinciding with wave 1 and the deployment of a provincial transplant triaging system. Transplants decreased by 14.6% in wave 2 (RR, 0.854; 95% CI, 0.770–0.947) and 23.1% in wave 3 (RR, 0.769; 95% CI, 0.690–0.857) despite the triaging system not being activated. Overall, there was a 24.3% decrease (RR, 0.757; 95% CI, 0.679–0.844) in transplant rates, equivalent to 409 fewer transplants. No sustained changes were observed in heart or liver but sustained and large decreases were seen for lung (RR, 0.664; 95% CI, 0.482–0.915) and kidney (RR, 0.721; 95% CI, 0.602–0.863) transplantation. A low prevalence (1.7%) of COVID-19 infection within 90 days of transplantation was seen. No differences were observed in other 90-day outcomes.

Conclusions — Early safety concerns limited transplantation to immediate life-saving procedures; however, the reductions in kidney and lung transplants continued for the rest of the pandemic, where no restrictions were in place.



Gomez D, Stukel TA, Baxter NN, Acuna SA, Wilton AS, Treleaven D, Ordon M, Kim SJ. Ann Surg Open. 2023; 4(1):e230. Epub 2023 Jan 5.

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