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

Abstract

Background. The risk of COVID-19 infection in transplant recipients (TRs) is unknown. Patients on dialysis may be exposed to greater risk of infection due to an inability to isolate. Consideration of these competing risks is important before restarting suspended transplant programs. This study compared outcomes in kidney and kidney/pancreas TRs with those on the waiting list, following admission with COVID-19 in a high-prevalence region. Methods. Audit data from all 6 London transplant centers were amalgamated. Demographic and laboratory data were collected and outcomes included mortality, intensive care (ITU) admission, and ventilation. Adult patients who had undergone a kidney or kidney/pancreas transplant, and those active on the transplant waiting list at the start of the pandemic were included. Results. One hundred twentyone TRs and 52 waiting list patients (WL) were admitted to hospital with COVID-19. Thirty-six TR died (30%), while 14 WL patients died (27% P = 0.71). There was no difference in rates of admission to ITU or ventilation. Twenty-four percent of TR required renal replacement therapy, and 12% lost their grafts. Lymphocyte nadir and D-dimer peak showed no difference in those who did and did not die. No other comorbidities or demographic factors were associated with mortality, except for age (odds ratio of 4.3 [95% CI 1.8-10.2] for mortality if aged over 60 y) in TR. Conclusions. TRs and waiting list patients have similar mortality rates after hospital admission with COVID-19. Mortality was higher in older TRs. These data should inform decisions about transplantation in the COVID era.

A propensity score-matched analysis of mortality in solid organ transplant patients with COVID-19 compared to non-solid organ transplant patients

“…Emerging data of the impact of COVID-19 in immunosupressed patients, including solid organ transplant (SOT recipients) has recently become available [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. SOT recipients may be at a greater risk for worse outcomes due to the detrimental effect of the immunosuppressive therapy, similar to other viral infections, however, while some studies reflected poorer outcomes [6,9,[16][17][18], other studies do not suggest worse prognosis compared to the non-transplant population [3][4][5]7,8,15,19].…”

Kidney transplantation and COVID-19 renal and patient prognosis

“…Most of the available data on survival involves long-term stable recipients, and there is scarce information regarding early transplant recipients. In studies in which the subgroup of early transplant recipients was analysed for ˂6 months [ 12 ] or ˂1 year [ 12 , 88 ], mortality was not different between groups, although in some of them there was a trend towards a higher mortality for the early group [ 12 ]. A recent report that included 24 recipients with COVID-19 diagnosed within 60 days after transplantation revealed a significant impact on patient survival with a mortality rate of 46% [ 89 ].…”

“…In a multicentre study in London, an area with a high prevalence of COVID-19 [ 100 ], outcomes after SARS-CoV-2 infection in kidney transplant recipients ( n = 121) were compared with patients on the waiting list ( n = 51). Although no differences in mortality were found (30% versus 27%), the only risk factor independently associated with mortality was being >60 years of age in the kidney transplant group [OR 4.3 (95% CI 1.8–10.2)] [ 88 ]. Finally, in contrast with the previous data, there is a single-centre study performed in London in which the overall survival on a population level between wait-listed and kidney transplant patients was not different, but the mortality rate following SARS-CoV-2 infection was higher in the renal transplant group (37% versus 11%) [ 90 ].…”

Risks and Benefits of Kidney Transplantation during the COVID-19 Pandemic: Transplant or Not Transplant?

“…Such studies are of interest as they would help make better informed decisions regarding whether to proceed with transplantation during the pandemic versus having the patient accrue time on the waiting list. We summarized the studies comparing transplant patients to wait-listed patients with COVID-19 disease in Table 3 9,11,[30][31][32][33][34][35] .…”

“…Another explanation is the increased exposure of waitlisted patients to virus while receiving in-center hemodialysis. Most studies, which were done in Europe, identified a much higher COVID-19 related mortality in transplant recipients versus waitlisted patients, ranging 20-37% vs 5-16%, respectively 9,11,[31][32][33][34][35] . The largest series came from France for the period March 1st through June 1, 2020 that identified 275 deaths among the 42,812 kidney transplant recipients and 144 deaths among the 16,210 candidates 35 .…”