Informing the Risk of Kidney Transplantation Versus Remaining on the Waitlist in the Coronavirus Disease 2019 Era

Abstract

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The authors reply

“…We agree with our colleagues [ 1 ] that the risk of death by COVID-19 integrates both the risk of infection by SARS-Cov-2 (higher in renal transplant candidates [ 2 ]), and that to develop a severe form of COVID-19 (higher in recipients [ 3 , 2 ]). Understanding how these distinct risks compare in each population is critical to establish appropriate guidelines.…”

“…A comment on the IMPORTANT study": one more IMPORTANT thing! Olivier Thaunat 1,2,3 , Camille Legeai 4 , Olivier Bastien 4 [2]), and that to develop a severe form of COVID-19 (higher in recipients [3,2]). Understanding how these distinct risks compare in each population is critical to establish appropriate guidelines.…”

Kidney transplantation and COVID-19 renal and patient prognosis

“…Although no differences in mortality were found (30% versus 27%), the only risk factor independently associated with mortality was being >60 years of age in the kidney transplant group [OR 4.3 (95% CI 1.8–10.2)] [ 88 ]. Finally, in contrast with the previous data, there is a single-centre study performed in London in which the overall survival on a population level between wait-listed and kidney transplant patients was not different, but the mortality rate following SARS-CoV-2 infection was higher in the renal transplant group (37% versus 11%) [ 90 ]. Few studies exist in the paediatric population, but the available data support that since chronic immunosuppression is not associated with an increased risk of COVID-19 in young kidney transplant patients, transplant activity should be maintained even in areas with a high incidence of SARS-CoV-2 infection [ 101 ].…”

“…Recipients who died were older (61 versus 70 years), received high-dose steroids less frequently (25% versus 82%) and usually needed ventilation support (15% versus 78%). In another study that included 237 patients in the first-year post-transplant, of whom 16 had a COVID-19 diagnosis, the mortality rate was 37% [ 90 ].…”

Panic in the Pandemic: When Should Kidney Transplant Programs Close?

“…Wait listed patients are also at increased risk of death from COVID-19. 22,23,24 • Case fatality rates in patients newly transplanted are not known, in part because many programs were suspended early on. One could assume the risk of death is higher during the period of intense immunosuppression.…”