Collapsing/sclerosing glomerulopathy (CSG) and acute tubular injury (ATI) in patients with COVID-19

Background: We surveyed U S transplant programs to assess practices, strategies and barriers related to living donor kidney transplantation (LDKT) in the context of the COVID-19 pandemic Methods: After IRB approval, the survey was launched 5/9/20 by email and postings to professional society list-servs, using the Qualtrics platform Data are reported through 5/27/20, and examined by state COVID-19 prevalence Results: Staff at 117 unique centers responded, representing 58% of U S living donor recovery centers and 75% of LKDT volume in the year before pandemic declaration Overall, 66% reported LDKT surgery was on hold (82% in high vs 50% in low prevalence states) 36% reported that evaluation of new donor candidates had paused, 27% reported evaluations were very decreased (>0% to <25% typical) and 23% reported evaluations were moderately decreased (25% to <50% typical) Barriers to LDKT surgery included program concerns for donor (84%) and recipient (75%) safety, patients concerns (54%), restrictions on elective cases (47%) and hospital administrative restrictions (47%) Programs with higher local COVID-19 prevalence reported more barriers related to staff and resource diversion (Figure) Most centers continuing donor evaluations used remote strategies (video 82%;telephone 43%) 61% of centers plan to continue more telehealth after the pandemic 32% plan to resume some LDKT within 2 wks and 27% within 1 month When surgery resumes, all will screen for COVID-19 before donation surgery, although timeframe and modalities vary Conclusions: COVID-19 has created many barriers to LDKT, especially in areas of highest prevalence Transplant centers are planning to restart LKDT cautiously Consensus-building is needed to reduce barriers, guide optimal practice, and facilitate safe restoration of LDKT across centers