SECTION TRANSPLANT HEPATOLOGY
Pandemic Impacts on Liver Transplantation
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 .
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 ( 1 ). 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 .
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 about 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 . •
1 . Kemme S , Yoeli D , Sundaram SS , Adams MA , Feldman AG . Decreased access to pediatric liver transplantation during the COVID-19 pandemic . Pediatr Transplant . 2022 Mar ; 26 ( 2 ): e14162 . doi : 10.1111 / petr . 14162 . Epub 2021 Oct 11 . PMID : 34633127 ; PMCID : PMC8646490 .
SHIKHA SUNDARAM , MD
Gastroenterology and Transplant Hepatology , Medical Director , Pediatric Liver Center , Children ’ s Hospital Colorado
Associate professor , Pediatrics- Gastroenterology , Hepatology and Nutrition , University of Colorado School of Medicine
MEGAN ADAMS , MD
Pediatric Transplant Hepatology and Transplant Nephrology , Children ’ s Hospital Colorado
Assistant professor , Surgery- Transplant , Associate Fellowship Director , University of Colorado School of Medicine
AMY FELDMAN , MD
Gastroenterology and Transplant Hepatology , Children ’ s Hospital Colorado
Associate professor , Pediatrics- Gastroenterology , Hepatology and Nutrition , Medical Director , Liver Transplant Program , University of Colorado School of Medicine
8 | CHILDREN ’ S HOSPITAL COLORADO