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

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.