Although solid organ transplantation was exempt from public health orders postponing nonessential procedures, the pandemic still had a dramatic impact on liver transplantation. Ethical concerns about exposing transplant recipients to COVID-19, logistical challenges, fewer waitlist additions due to patient hesitancy and racial and ethnic disparities affected access to liver transplants (LT) in the adult population, and children faced similar challenges. But there were also a few key differences.
Declining rates of transplantation
A Children’s Hospital Colorado study of pediatric LT during the COVID-19 pandemic found a 38% decrease in the rate of transplantation compared to pre-pandemic rates. This data demonstrated a smaller burden on the pediatric population compared with adults, who saw a large increase in waitlist deaths due to COVID-19. This aligns with the overall impact of COVID-19 in pediatrics, where children generally haven’t experienced the same level of disease severity and hospitalizations as adults.
No changes in living donor transplants
Most surprisingly, the researchers found no decrease in the percentage of living donor liver transplants (LDLTs) performed. This too was different in the adult population, which saw 42% fewer LDLTs during early COVID-19. Researchers speculate that this difference could be explained by policy decisions to continue transplants due to the difficulty of finding size-appropriate childhood grafts. There are still questions if living donors and donor recipients were at higher risk for infectious complications or poor outcomes during this time, requiring additional research.
The study also highlighted important racial differences observed in pediatric access to LT, with Black children disproportionately affected by lower waitlist additions, and nonwhite children seeing a decrease in overall LTs and LDLTs during the early stages of the pandemic. This was yet another example of how racial and ethnic minorities have been disproportionately affected by the burden of the pandemic. The researchers acknowledge that further research is urgently needed to ensure equal access to LT.