Informing the Risk of Kidney Transplantation Versus Remaining on the Waitlist in the Coronavirus Disease 2019 Era
Candice Clarke, Gaetano Lucisano, Maria Prendecki, Sarah Gleeson, Paul Martin, Mahrukh Ayesha Ali, Stephen P. McAdoo, Liz Lightstone, Damien Ashby, Rawya Charif, Megan Griffith, Adam McLean, Frank J. M. F. Dor, Michelle Willicombe, Maura Appelbe, Edwina A. Brown, Tom Cairns, Caroline Clerkin, Marie Condon, Richard Corbett, Jeremy Crane, Frank J. M. F. Dor, Neill Duncan, Claire Edwards, Fabiana Fernandes da costa, Andrew Frankel, Dawn Goodall, Julie M. Harris, Sharon Harris, Paul Herbert, Peter Hill, Andreas Kousios, Jeremy Levy, Lian Liu, Marina Loucaidou, Kathleen Lynch, Nicholas Medjeral‐Thomas, Dihlabelo Moabi, Anand Muthusamy, Margaret Nevin, Andrew Palmer, D. S. Parsons, Virginia Prout, S. Punzalan, Emma Salisbury, Eleanor Sandhu, Colin Smith, Roland Storey, Anisha Tanna, Katie Tansey, David Thomas, James Tomlinson, Vassilios Papalois, Phil Webster, Dejing Yang
Abstract
IntroductionThere are limited data pertaining to comparative outcomes of remaining on dialysis versus kidney transplantation as the threat of coronavirus disease 2019 (COVID-19) remains. In this study we delineate the differential risks involved using serologic methods to help define exposure rates.MethodsFrom a cohort of 1433 patients with end-stage kidney disease (ESKD), we analyzed COVID-19 infection rates and outcomes in 299 waitlist patients compared with 237 transplant recipients within their first year post-transplant. Patients were followed over a 68-day period from the time our transplant program closed due to COVID-19.ResultsThe overall mortality rates in waitlist and transplant populations were equivalent (P = 0.69). However, COVID-19 infection was more commonly diagnosed in the waitlist patients (P = 0.001), who were more likely to be tested by reverse transcriptase polymerase chain reaction (P = 0.0004). Once infection was confirmed, mortality risk was higher in the transplant patients (P = 0.015). The seroprevalence in dialysis and transplant patients with undetected infection was 18.3% and 4.6%, respectively (P = 0.0001). After adjusting for potential screening bias, the relative risk of death after a diagnosis of COVID-19 remained higher in transplant recipients (hazard ratio = 3.36 [95% confidence interval = 1.19–9.50], P = 0.022).ConclusionsAlthough COVID-19 infection was more common in the waitlist patients, a higher COVID-19‒associated mortality rate was seen in the transplant recipients, resulting in comparable overall mortality rates.