Impact of the Kidney Transplantation Moratorium in France Because of the COVID-19 Pandemic: A Cohort-based Study

Abstract

Original Clinical Science-General Background. The COVID-19 pandemic has resulted in worldwide kidney transplantation (KT) moratoriums. The impacts of these moratoriums on the life expectancy of KT candidates remain unclear. Methods. We simulated the evolution of several French candidate populations for KT using a multistate semi-Markovian approach and according to moratorium durations ranging from 0 to 24 mo. The transition rates were modeled from the 63 927 French patients who began dialysis or were registered on the waiting list for KT between 2011 and 2019. Results. Among the 8350 patients active on the waiting list at the time of the French KT moratorium decided on March 16, 2020, for 2.5 mo, we predicted 4.0 additional months (confidence interval [CI], 2.8-5.0) on the waiting list and 42 additional deaths (CI, -70 to 150) up to March 16, 2030, compared with the scenario without moratorium. In this population, we reported a significant impact for a 9-mo moratorium duration: 135 attributable deaths (CI, 31-257) up to March 16, 2030. Patients who became active on the list after March 2020 were less impacted; there was a significant impact for an 18-mo moratorium (175 additional deaths [CI,) in the 10 862 prevalent end-stage renal disease patients on March 16, 2020 and for a 24-mo moratorium (189 additional deaths [CI,) in the 16 355 incident end-stage renal disease patients after this date. Conclusion. The temporary moratorium of KT during a COVID-19 peak represents a sustainable decision to free up hospitals' resources if the moratorium does not exceed a prolonged period.

What does the French REIN registry tell us about Stage 4-5 CKD care in older adults?

“…For example, the impacts of kidney transplantation moratorium on the life expectancy of kidney transplantation candidates was simulated. Patients older than 60 were less impacted by KT moratoriums: they had a lower additional time on the waitlist and a lower overmortality than younger patients in each of the three studied populations ( 99 ). The role of registers as potential health monitoring tools is greatly underestimated.…”

The Challenges of Risk Aversion in Kidney Transplantation: Lessons From the SARS-CoV-2 Pandemic in Brazil

“…7,8 Although the initial perspective on transplant safety during the pandemic was widely accepted, the transplant community soon began to recognize the unavoidable cascade of consequences, including a significant increase of patients on waiting lists with an additional burden for the management of patients struggling with chronic kidney disease. [9][10][11] RESPONDING TO THE CRISIS Under the leadership of our transplant center, a series of proactive measures were implemented to address and manage the nationwide consequences of the pandemic. In this approach, we have been guided by 2 distinct objectives: First, we aimed to establish seamless and direct communication channels among various transplant centers.…”

“…7,8 Although the initial perspective on transplant safety during the pandemic was widely accepted, the transplant community soon began to recognize the unavoidable cascade of consequences, including a significant increase of patients on waiting lists with an additional burden for the management of patients struggling with chronic kidney disease. 9-11…”