Outcomes of Patients Receiving a Kidney Transplant or Remaining on the Transplant Waiting List at the Epicentre of the COVID-19 Pandemic in Europe: An Observational Comparative Study

Abstract

Since the declaration of the COVID-19 pandemic, the number of kidney transplants (KT) performed worldwide has plummeted. Besides the generalised healthcare crisis, this unprecedented drop has multiple explanations such as the risk of viral transmission through the allograft, the perceived increase in SARS-CoV-2-related morbidity and mortality in immunocompromised hosts, and the virtual “safety” of dialysis while awaiting effective antiviral prophylaxis or treatment. Our institution, operating at the epicentre of the COVID-19 pandemic in Italy, has continued the KT programme without pre-set limitations. In this single-centre retrospective observational study with one-year follow-up, we assessed the outcomes of patients who had undergone KT (KTR) or remained on the transplant waiting list (TWL), before (Pre-COV) or during (COV) the pandemic. The main demographic and clinical characteristics of the patients on the TWL or receiving a KT were very similar in the two periods. The pandemic did not affect post-transplant recipient and allograft loss rates. On the contrary, there was a trend toward higher mortality among COV-TWL patients compared to Pre-COV-TWL subjects. Such a discrepancy was primarily due to SARS-CoV-2 infections. Chronic exposure to immunosuppression, incidence of delayed allograft function, and rejection rates were comparable. However, after one year, COV-KTR showed significantly higher median serum creatinine than Pre-COV-KTR. Our data confirm that KT practice could be safely maintained during the COVID-19 pandemic, with excellent patient- and allograft-related outcomes. Strict infection control strategies, aggressive follow-up monitoring, and preservation of dedicated personnel and resources are key factors for the optimisation of the results in case of future pandemics.

A Keynesian perspective on the health economics of kidney transplantation would strengthen the value of the whole organ donation and transplantation service

“…We analyzed the volume activity of the ODT services in the Lazio region of Italy for 5 consecutive years (namely, from 1 January 2015 to 31 December 2019). The years 2020 and 2021 have not been included because the COVID-19 pandemic did substantially influence ODT activity globally ( 7 – 9 ). The OD activity was evaluated through the number of utilized donors (UD) defined as donors from whom at least one organ was transplanted ( 10 ).…”

Managing the “Sword of Damocles” of Immunosuppression: Prevention, Early Diagnosis, and Treatment of Infectious Diseases in Kidney Transplantation

“…The ongoing SARS-CoV-2 pandemic has forced the transplant community, our patients, and their families to make highly complex decisions [ 10 , 11 ], particularly at a time when non-pharmaceutical interventions were the only measure available to protect the most vulnerable and immunosuppressed patients [ 12 ]. The impact of COVID-19 in the geographical “epicentre” of the pandemic is clearly presented by Perego et al [ 13 ]. Dedicated personnel and patient pathways, together with the relentless application of preventive measures, have allowed the viability of the KT services to be maintained.…”