Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France; Kidney Transplant Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France.
Lancet Public Health. 2021 Oct;6(10):e709-e719. doi: 10.1016/S2468-2667(21)00200-0. Epub 2021 Aug 30.
Preliminary data suggest that COVID-19 has reduced access to solid organ transplantation. However, the global consequences of the COVID-19 pandemic on transplantation rates and the effect on waitlisted patients have not been reported. We aimed to assess the effect of the COVID-19 pandemic on transplantation and investigate if the pandemic was associated with heterogeneous adaptation in terms of organ transplantation, with ensuing consequences for waitlisted patients.
In this population-based, observational, before-and-after study, we collected and validated nationwide cohorts of consecutive kidney, liver, lung, and heart transplants from 22 countries. Data were collected from Jan 1 to Dec 31, 2020, along with data from the same period in 2019. The analysis was done from the onset of the 100th cumulative COVID-19 case through to Dec 31, 2020. We assessed the effect of the pandemic on the worldwide organ transplantation rate and the disparity in transplant numbers within each country. We estimated the number of waitlisted patient life-years lost due to the negative effects of the pandemic. The study is registered with ClinicalTrials.gov, NCT04416256.
Transplant activity in all countries studied showed an overall decrease during the pandemic. Kidney transplantation was the most affected, followed by lung, liver, and heart. We identified three organ transplant rate patterns, as follows: countries with a sharp decrease in transplantation rate with a low COVID-19-related death rate; countries with a moderate decrease in transplantation rate with a moderate COVID-19-related death rate; and countries with a slight decrease in transplantation rate despite a high COVID-19-related death rate. Temporal trends revealed a marked worldwide reduction in transplant activity during the first 3 months of the pandemic, with losses stabilising after June, 2020, but decreasing again from October to December, 2020. The overall reduction in transplants during the observation time period translated to 48 239 waitlisted patient life-years lost.
We quantified the impact of the COVID-19 pandemic on worldwide organ transplantation activity and revealed heterogeneous adaptation in terms of organ transplantation, both at national levels and within countries, with detrimental consequences for waitlisted patients. Understanding how different countries and health-care systems responded to COVID-19-related challenges could facilitate improved pandemic preparedness, notably, how to safely maintain transplant programmes, both with immediate and non-immediate life-saving potential, to prevent loss of patient life-years.
French national research agency (INSERM) ATIP Avenir and Fondation Bettencourt Schueller.
初步数据表明，COVID-19 降低了实体器官移植的可及性。然而，COVID-19 大流行对移植率的全球影响以及对等候名单患者的影响尚未报道。我们旨在评估 COVID-19 大流行对移植的影响，并研究大流行是否与器官移植方面的异质适应有关，从而对等候名单患者产生相应的后果。
在这项基于人群的观察性前后对照研究中，我们从 22 个国家收集并验证了连续肾、肝、肺和心脏移植的全国性队列。数据收集时间为 2020 年 1 月 1 日至 12 月 31 日，并与 2019 年同期数据进行了比较。分析从第 100 例累积 COVID-19 病例开始，一直持续到 2020 年 12 月 31 日。我们评估了大流行对全球器官移植率的影响以及每个国家内移植数量的差异。我们估计了由于大流行的负面影响而导致的等候名单患者生命年损失的数量。该研究在 ClinicalTrials.gov 上注册，编号为 NCT04416256。
所有研究国家的移植活动在大流行期间总体呈下降趋势。肾移植受影响最大，其次是肺、肝和心脏。我们确定了三种器官移植率模式，如下所示：移植率急剧下降且 COVID-19 相关死亡率低的国家；移植率中度下降且 COVID-19 相关死亡率中度的国家；移植率略有下降但 COVID-19 相关死亡率高的国家。时间趋势显示，大流行的前 3 个月全球移植活动明显减少，2020 年 6 月后损失趋于稳定，但 2020 年 10 月至 12 月再次下降。在观察期间，整体移植量的减少导致 48239 名等候名单患者生命年损失。
我们量化了 COVID-19 大流行对全球器官移植活动的影响，并揭示了国家层面和国家内部器官移植方面的异质适应，这对等候名单患者产生了不利影响。了解不同国家和医疗保健系统如何应对 COVID-19 相关挑战可以促进更好的大流行准备，特别是如何安全地维持具有即时和非即时救生潜力的移植计划，以防止患者生命年损失。
法国国家研究机构（INSERM）ATIP Avenir 和 Bettencourt Schueller 基金会。
