Mortality rates in transplant recipients and transplantation candidates in a high prevalence COVID-19 environment.

Background The risk of COVID-19 infection in transplant recipients 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 transplant recipients with those on the waiting list, following admission with COVID-19 in a high prevalence region. Methods Audit data from all 6 London transplant centres 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 121 transplant recipients (TR) and 52 waiting list patients (WL) were admitted to hospital with COVID-19. 36 TR died (30%), whilst 14 WL patients died (27% p=0.71). There was no difference in rates of admission to ITU or ventilation. 24% 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 co-morbidities 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 years) in TR. Conclusions Transplant recipients and waiting list patients have similar mortality rates after hospital admission with COVID-19. Mortality was higher in older transplant recipients. These data should inform decisions about transplantation in the COVID era.