Impact of COVID-19 on kidney transplantation

Background: Detrimental impact of COVID-19 on renal function unraveled over time. Nephrology community was in a dilemma whether transplantation should continue under such circumstances. We investigated which States within the US continued to perform kidney transplantation despite such odds. Methods: Retrospective data from Organ Procurement and Transplantation Network (OPTN) regions for kidney transplant alone (KTA) performed across the US from 2019 to 2020, reflecting the peak of the first wave of COVID -19 pandemic were analyzed. To address whether the COVID-19 had an impact on transplanted kidneys, we analyzed graft survival at 3-and 6-months post-transplant during that era. We further investigated the statewide variation of KTA in both deceased donor (DD) transplants and living donor (LD) transplants. Results: There was a 3.1% decrease in KTA from 2019 to 2020 (22,429 to 21,731). There was an overall trend of a decrease in number of transplants across all states with a peak decline in March-April 2019 era and rebound in May 2019 onwards. Statewide regional decline or variation of DD KTA was most significant in region 9 (NY, Vermont) while regions 4 (Oklahoma and Texas) continued to perform transplants unabated. In 2019, 30.6% of KTA were from LD while in 2020 the rate decreased to 24.1%. The transplantations of DD increased from 15,562 to 16,497 in 2020. Overall, 3-month graft survival was significantly negatively impacted for DD KTA performed between February and May. The decrease in KTA in the southern regions was less compared to the northeastern regions. Conclusions: The COVID-19 pandemic had a major impact on kidney transplantation with a significant reduction within all OPTN regions. While LD transplantation could presumably be rescheduled, DD organs must be procured immediately, or they are lost. Therefore, the number of DD transplants decreased initially between March and May but recovered afterwards. Transplanted kidneys during COVID-19 first wave pandemic era performed reasonably well but with an increase rate of injury and rejection.