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Informing the risk of kidney transplantation versus remaining on the wait list in the COVID-19 era

  • Clarke, C
  • Lucisano, G
  • Prendecki, M
  • Gleeson, S
  • Martin, P
  • Ali, M
  • McAdoo, SP
  • Lightstone, L
  • Ashby, D
  • Charif, R
  • Griffith, M
  • McLean, A
  • Dor, F
  • Willicombe, M
  • covid group, ichnt renal
Publication Date
Oct 27, 2020
UPCommons. Portal del coneixement obert de la UPC
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Introduction: There is limited data pertaining to comparative outcomes of remaining on dialysis versus kidney transplantation as the threat of COVID-19 remains. This study aims to delineate the differential risks involved using serological methods to help define exposure rates. Methods: From a cohort of 1433 patients with ESKD, we analysed COVID-19 infection rates and outcomes in 299 wait list patients compared with 237 transplant recipients within their first year post-transplant. Patients were followed over a 68-day period from the time our transplant programme closed due to COVID-19. Results: The overall mortality rate in wait list and transplant populations were equivalent, p=0.69. However, COVID-19 infection was more commonly diagnosed in the wait list patients, p=0.001, who were more likely to be tested by RT-PCR, p=0.0004. Once infection was confirmed, mortality risk was higher in the transplant patients, p=0.015. The seroprevalence in dialysis and transplant patients with undetected infection was 18.3% and 4.6% respectively, p=0.0001. After adjusting for a potential screening bias, the relative risk of death following a diagnosis of COVID-19 remained higher in transplant recipients, HR: 3.36 (1.19-9.50), p=0.022. Conclusions: In conclusion, whilst COVID-19 infection was more common in the wait list patients, a higher COVID-19 associated mortality rate was seen in transplant recipients, resulting in comparable overall mortality rates.

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