Why haven’t transplant numbers recovered post COVID-19? Evaluating a national cardiothoracic centre

Abstract Background The COVID-19 pandemic caused significant disruptions to cardiothoracic surgery and transplant services globally, with our initial 2020 study reporting a 50% reduction in activity during March–April 2020. This follow-up assesses persistent impacts and recovery patterns five years post-onset. Methods A retrospective review of prospectively collected data from a National Cardiothoracic Transplant Unit was conducted for 2019–2025. Annual volumes were compared to 2019 baselines, with subgroup analyses by procedure and acuity. Results Total annual cardiothoracic cases dropped to 49% of 2019 levels in 2021 (251 vs 510) before a gradual recovery: 73% in 2022, 87% in 2023, 91% in 2024, and 96% in 2025. Early pandemic impacts were most pronounced in 2021, with January-April volumes at 27% (40 vs. 149). Procedure-specific trends varied: CABG surgery recovered to 103% by 2024 (319 vs. 309); valve surgery exceeded baseline at 116% by 2025 (116 vs. 100); Aortic surgery reached 78% by 2025. Transplant numbers fell 52% from 2019 to 2020 (52 vs 25) and have failed to increase since, still sitting at half of 2019 volumes. Heart transplants are at 33–67% (5–10 vs 15) and lungs at 35–51% (13–19 vs 37) of pre Covid levels per annum. Acuity remained relatively unchanged during the study period. Conclusions Cardiothoracic surgery volumes largely recovered by 2024, but transplants volume as well as aortic procedures have failed to recover to pre COVID levels. These findings underscore the need for targeted interventions to address backlogs and enhance transplant services in Ireland.