COVID-19–Associated Mortality among Kidney Transplant Recipients and Candidates in the United States

Abstract

Background and Objectives: The COVID-19 pandemic has had a profound impact on transplantation activity in the United States and globally. Several single center reports suggest higher morbidity and mortality among candidates waitlisted for a kidney transplant as well as recipients of a kidney transplant. We aim to describe 2020 mortality patterns during the COVID-19 pandemic in the United States among kidney transplant candidates and recipients. Design, Setting, Participants, and Measurements: Using national registry data for waitlisted candidates and kidney transplant recipients collected through April 23, 2021, we report demographic and clinical factors associated with COVID-19 related mortality in 2020, other deaths in 2020 and deaths in 2019 among waitlisted candidates and transplant recipients . We quantify excess all-cause deaths among candidate and recipient populations in 2020 as well as deaths directly attributed to COVID-19 in relation to pre-pandemic mortality patterns in 2019 and 2018. Results: Among waitlisted patient deaths in 2020, 11% of deaths were attributed to COVID-19, and these candidates were more likely to be male, obese, and belong to a racial/ethnic minority group. Nearly 1 in 6 deaths (16%) among active transplant recipients in the United States in 2020 was attributed to COVID-19. Recipients who died of COVID-19 were younger, more likely to be obese, had lower educational attainment, and were more likely to belong to racial/ethnic minority groups than those who died of other causes in 2020 or 2019. We found higher overall mortality in 2020 among waitlisted candidates (24%) than among kidney transplant recipients (20%) compared to 2019. Conclusions: Our analysis demonstrates higher rates of mortality associated with COVID-19 among waitlisted candidates and kidney transplant recipients in the United States in 2020.

Insights From Early Clinical Trials Assessing Response to mRNA SARS-CoV-2 Vaccination in Immunocompromised Patients

“…A number of studies have confirmed that immunocompromised patients are at high risk of developing severe COVID-19 disease and of dying when infected with SARS-CoV-2 (65)(66)(67)(68). This seems to be particularly the case in patients with combined defects of B and T cell immunity as observed early after transplantation as well as in patients given intensive chemotherapy (69)(70)(71)(72)(73). Anti-CD20 therapy inducing a profound B-cell depletion also increases the risk of severe COVID-19 and death (74)(75)(76).…”

Survey of current transplant center practices regarding COVID-19 vaccine mandates in the United States

“…Mohan et al recently reported that 16% of all deaths among kidney transplant recipients and 11% of all deaths on the kidney transplant waiting list in 2020 were due to SARS‐CoV‐2 infection. 1 An Italian survey reported a 32.7% mortality among liver transplant candidates during the public health emergency, increasing to 45% among those with a Model for End‐Stage Liver Disease (MELD) score >15. 2 It has been demonstrated that solid‐organ transplant recipients on immunosuppression tend to be hyporesponsive to COVID‐19 vaccines, particularly those taking antimetabolites.…”

Heterologous Ad.26.COV2.S versus homologous BNT162b2/mRNA-1273 as a third dose in solid organ transplant recipients seronegative after two-dose mRNA vaccination

“…SARS‐CoV‐2 infection causes substantial morbidity and mortality in solid organ transplant recipients (SOTRs). 1 , 2 , 3 , 4 Vaccination holds promise to reduce COVID‐19 severity in SOTRs, but a significant subset does not develop antibody response after two‐ and three‐dose mRNA vaccine series, 5 , 6 , 7 , 8 which likely contributes to higher rates of COVID‐19 breakthrough after vaccination. 4 Heterologous vaccination (“mixing platforms”) is one potential mode to augment aspects of immune sero‐response, 9 , 10 , 11 , 12 but data are limited in SOTRs.…”