How contemporary living kidney donor transplants compare to prepandemic trends: An interrupted time series analysis

Living donor kidney transplants (LDKTs) are vital for access to transplantation among patients with kidney disease. Little research has been conducted on LDKT behaviors after the coronavirus disease 2019 (COVID-19) pandemic. Our aim was to analyze donor and recipient patterns in contemporary LDKT trends after the health system shock from the pandemic. Using national Scientific Registry of Transplant Recipients and Census data, we calculated monthly rates of adult LDKTs per 10 million population overall, by donor relationship, and by recipient characteristics from January 2015 to December 2024. We performed single- and multiple-group, multiple-intervention interrupted time series analysis to compare pre- and post-COVID-19 LDKT trends. Across 52 403 LDKTs, there was no overall change in LDKTs between pre- and post-COVID-19 periods. However, in stratified analyses, there were 0.037 fewer unrelated LDKTs per 10 million population per month post-COVID-19 than the pre-COVID-19 period. Unrelated LDKT trend differences were significantly lower than LDKT trend differences for biological, partnered, and other donors and corresponded to 1094, 1532, and 1422 fewer unrelated LDKTs post-COVID-19, respectively. This decline in unrelated LDKTs directly attributed to fewer LDKTs among Black and ≥60-year-old recipients. Changes in unrelated donor characteristics point toward socioeconomic and medical distrust as potential reasons for declining donations, although more research is needed to verify these mechanisms.