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Kidney Week

Abstract: SA-OR27

Kidney Transplant Graft Loss During 2020

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Johansen, Kirsten L., Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Gilbertson, David T., Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Liu, Jiannong, Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Horak, Kayla L., Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Ku, Elaine, University of California San Francisco, San Francisco, California, United States
Background

We hypothesized that disruption of clinical care during the COVID-19 pandemic in 2020 led to an increase in kidney transplant graft loss compared with rates in 2018 and 2019.

Methods

We examined point prevalent cohorts of adult kidney transplant (KT) recipients with functioning allografts on January 1 of 2018, 2019, and 2020. We calculated rates of all-cause graft loss and death-censored graft loss during each quarter. We used Poisson regression to estimate incidence rate ratios (IRR) for each quarter, comparing rates in 2020 to those in 2018-2019, adjusting for age, sex, race/ethnicity, type of donor, and duration of transplant (<1 year, ≥1 year).

Results

There were 220,079, 228,549, and 238,578 individuals in the 2018, 2019, and 2020 cohorts. In 2020, mean age was 55.3 years, 62.4% were deceased donor KT recipients, and 9.8% were within one year of KT. 51.9% were White, 20.5% Black, 16.1% Hispanic, and 11.4% other. All-cause graft failure rates ranged from 5.6 to 6.8 per 100 person years and death-censored rates from 2.6 to 3.2 per 100 person years. Compared with earlier years, rates of all-cause graft loss were higher in quarters 2-4 of 2020 (Table). There was a statistically significant interaction between race/ethnicity and year (2018-2019 vs 2020) across quarters; during 2020, there was a greater increase in all-cause graft loss among Black and Hispanic than among White individuals. Contrary to our hypothesis, there was no statistically significant increase in death-censored graft loss in 2020 compared with 2018-2019 overall or for any race/ethnicity group. The increase in overall graft loss in 2020 and the stable or lower rates of death-censored graft loss were consistent among recipients with shorter (<1 year) versus longer graft vintage (p-values for interaction >0.3).

Conclusion

All-cause graft loss increased in 2020 compared with 2018-2019, but death-censored graft loss did not. COVID-19 related mortality likely dominated all-cause graft loss, but surviving patients did not experience higher rates of graft loss.

IRR for all-cause and death-censored graft loss in 2020 compared with 2018-2019
QuarterAll-cause graft failure, IRR (95% CI)Death-censored graft failure, IRR (95% CI)
Quarter 1 (Jan-Mar)0.94 (0.90, 0.98)0.93 (0.88, 0.98)
Quarter 2 (Apr-Jun)1.10 (1.05, 1.14)0.87 (0.82, 0.93)
Quarter 3 (Jul-Sept)1.14 (1.10, 1.19)0.97 (0.92, 1.04)
Quarter 4 (Oct-Dec)1.24 (1.19, 1.29)0.90 (0.85, 0.96)

Funding

  • NIDDK Support