Mortality Rates in Transplant Recipients and Transplantation Candidates in a High-prevalence COVID-19 Environment

Area of Science:

• Nephrology
• Immunology
• Infectious Diseases

Background:

• The risk of COVID-19 for transplant recipients (TRs) was unclear, with dialysis patients potentially at higher risk.
• Restarting suspended transplant programs requires careful consideration of risks for TRs and those on dialysis.
• This study investigated COVID-19 outcomes in kidney and kidney/pancreas TRs versus waiting list (WL) patients.

Purpose of the Study:

• To compare COVID-19 outcomes between kidney/kidney-pancreas transplant recipients and individuals on the transplant waiting list.
• To assess mortality, intensive care unit (ITU) admission, and ventilation rates in these groups.
• To identify factors influencing mortality in transplant recipients with COVID-19.

Main Methods:

• Amalgamated audit data from six London transplant centers.
• Collected demographic and laboratory data for adult kidney/kidney-pancreas TRs and active WL patients.
• Included outcomes such as mortality, ITU admission, and need for ventilation.

Main Results:

• 121 TRs and 52 WL patients were admitted with COVID-19; mortality was 30% for TRs and 27% for WL patients (P=0.71).
• No significant differences were observed in ITU admission or ventilation rates between groups.
• Older age (over 60) was associated with increased mortality in TRs (OR 4.3).
• 24% of TRs required renal replacement therapy, and 12% lost their grafts.

Conclusions:

• Transplant recipients and waiting list patients exhibit similar mortality rates following COVID-19 hospital admission.
• Older transplant recipients experienced higher mortality rates.
• Findings provide crucial data for guiding transplantation decisions in the COVID-19 era.