The impact of COVID-19 on kidney transplantation and the kidney transplant recipient - One year into the pandemic

Abstract

The COVID-19 pandemic has significantly changed the landscape of kidney transplantation in the United States and worldwide. In addition to adversely impacting allograft and patient survival in postkidney transplant recipients, the current pandemic has affected all aspects of transplant care, including transplant referrals and listing, organ donation rates, organ procurement and shipping, and waitlist mortality. Critical decisions were made during this period by transplant centers and individual transplant physicians taking into consideration patient safety and resource utilization. As countries have begun administering the COVID vaccines, new and important considerations pertinent to our transplant population have arisen. This comprehensive review focuses on the impact of COVID-19 on kidney transplantation rates, mortality, policy decisions, and the clinical management of transplanted patients infected with COVID-19.

Keywords: COVID-19; kidney transplantation; mortality; wait list.

Figure 1

Suggested algorithm for the management of the COVID‐19‐positive kidney transplant recipient. *Symptoms of upper respiratory tract infection, gastrointestinal symptoms, and loss of taste or smell could be present in all patients. Mildly symptomatic is defined as a patient who has oxygen saturation > 95%, has no tachypnea, and has no evidence of COVID‐19 on imaging. Moderately symptomatic is defined as a patient who has evidence of COVID‐19 on imaging, but has an oxygen saturation > 94% and a respiratory rate < 30. Severely symptomatic is defined as a patient who has a low oxygen saturation < 94% or a respiratory rate > 30 despite supplemental oxygen, or respiratory failure requiring mechanical ventilation. ^Physicians can consider stopping CNI/mTORi in select patients who are at low risk for rejection. #There is significant variation between individual countries in Remdesivir indications.

Figure 2

Factors affecting kidney transplant rates during the COVID‐19 pandemic. ICU: intensive care unit; PPE: personal protective equipment. *Due to COVID‐19 infection.