Heart Transplant Activity in France during the COVID-19 Outbreak

Purpose The COVID-19 pandemic has deeply affected organ transplant activity across the world. While the Agence de la biomedecine in agreement with the French lung transplant community has limited the transplant program to patients with high-urgency status during the first epidemic wave, the program has been fully restored where possible during the second epidemic wave. This study aimed to examine the impact of COVID-19 on new listings, waitlist outcomes and transplant activity in France. Methods All patients newly registered on the national waiting list for lung transplantation between January and September 2018-2020 were included in the study (n=878). The numbers of new listings and transplants per million population (pmp) in 2018-2019 period and in 2020 COVID era were compared. Cumulative incidence of transplantation and waitlist mortality estimated with the competing risk analysis with transplantation and death or delisting for medical condition as the competing events were compared between the study periods. Results In 2020 compared with the 2018-2019 period, the total number of patients newly registered on the waiting list declined 34%, from 4.9 to 3.2 pmp and the number of transplants performed decreased 31%, from 3.9 to 2.6 pmp. While 3-month cumulative incidence of transplantation (Figure 1) decreased from 54% [51-58] to 46% [39-53], no difference in cumulative incidence of death or delisting for medical condition (3% [2-4] versus 4% [2-8]) (Figure 2) was observed between the periods. Conclusion In 2020 COVID era, the waitlist and transplant access significantly declined in France without change in waitlist mortality.