Introduction: The COVID-19 pandemic paralyzed and changed medical practice all over the world. Its impact is indisputable specifically on immune-compromised patients. We wanted to know how this pandemic impacted pancreas transplantation in the USA.

Methods: All 4,883 U.S. pancreas transplants in diabetic patients performed between 1/2019 and 12/2020 were included. To assess the full impact of COVID-19, we compared monthly 2020 transplants, reflecting the peak of the first wave of the COVID -19 pandemic, with the respective transplants in 2019. A comprehensive comparison was performed regarding the number, the characteristics, the change in transplants and the 3- and 6-month graft survival between 2019 and 2020 according to transplant month. The development in pancreas transplantation was compared to the reported monthly numbers and deaths of COVID-19 patients.  An additional comparison of OPTN regions with related incidence rates was performed. All patients had at least a follow-up of 3 months post-transplant. However, due to the short follow-up at this time of analysis, outcomes only for the months from January to July were assessed.

Results: The number of pancreas transplants in the USA declined overall by 6% in 2020. A significant decline was only found for the months of March and April with subsequent recovery (Figure 1).
.
The decline in solitary transplants (9%) was significantly higher compared to SPK (6%). Significant regional differences were noted. For example, regions 4 (Oklahoma, Texas) increased their transplant numbers whereas in regions 9 (New York, Western Vermont) the numbers significantly declined. The transplant numbers especially declined significantly for low volume centers in 2020 (-36%) compared to high volume centers; the latter increased their volumes by 4% compared to the previous year. Race did not impact the change in pancreas transplantation rates (p=0.9). A strong initial association with the reported number of COVID-19 deaths was observed. Comparison with the number of new COVID-19 cases did not show a relationship over the analyzed time period. 3-month patient survival showed only for transplants performed in March 2020 a significantly lower patient survival rate; pancreas graft survival was lower for March and June transplants, but the differences were not significant (Figure 2).
.
Summary: The Covid-19 pandemic had an overall significant impact on pancreas transplantation with a reduction in transplant numbers. While patient survival was only initially impacted, short-term graft survival remained relatively stable over the analyzed time period. Longer follow-up is needed to fully understand the impact of the disease.