Abstract: SA-PO1128
Post-Kidney Transplant Allograft Failures and Patient Deaths: Donor COVID-19 Status and Pandemic-Era Effects
Session Information
- Transplantation: Clinical - Infectious Diseases
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- de Silva, Sajith, The University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
- Litvinovich, Igor, The University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
- Chong, Kelly, The University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
- Ng, Yue-Harn, University of Washington School of Medicine, Seattle, Washington, United States
- Kataria, Ashish, University of Kentucky College of Medicine, Lexington, Kentucky, United States
- Singh, Pooja P., The University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
- Argyropoulos, Christos, The University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
- Zhu, Yiliang, The University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
Background
The COVID-19 pandemic altered deceased-donor organ utilization and delivery of transplant care. However, the impact of the kidneys from SARS-CoV-2 positive donors, as well as the broader effects of the pandemic era on kidney transplant outcomes, remain incompletely characterized.
Methods
We conducted a retrospective cohort study of adult, first-time deceased-donor kidney transplant recipients in the United States from 2015 to 2024. We examined the associations of donor COVID-19 status at the time of transplant (positive vs. negative) and transplant era (pre-pandemic vs. pandemic/post-pandemic) with allograft failures and patient deaths. Time-to-event analyses were performed using multivariable Cox proportional hazards models for the outcomes, adjusting for donor and patient characters (paired when feasible), and transplant-related factors.
Results
Among 132,683 kidney recipients, 3.5% of the donors were COVID-19 positive. Compared to pre-pandemic transplants, recipients of COVID-19 positive donors were associated with an accelerated allograft failure (adjusted hazard ratio [aHR] = 1.26, 95% CI = 1.10–1.44), while COVID-19 negative donors was associated with a modest increased risk (aHR = 1.07, 95% CI = 1.01–1.12) [Table 1]. The risks of patient death were elevated during and post COVID compared with pre-COVID period for recipients of COVID-19 positive donors (aHR = 1.06, 95% CI = 0.93–1.22), negative donors (aHR = 1.17, 95% CI = 1.13–1.23) as well as status unknown donors (aHR = 1.34, CI=1.22 – 1.46). These associations were adjusted for donor and recipient characteristics, center effects, and transplant factors.
Conclusion
Risk of patient death was elevated during the COVID-19 era, irrespective of donor COVID status. COVID-19 positive donors was associated with elevated risk of allograft loss. These findings support continued monitoring of the use of COVID-19 positive donors regarding transplant outcomes while acknowledging the disruptive effects of COVID lingering on the healthcare system and kidney transplantation.
Table 1: Survival models for allograft failures and patient deaths
| Allograft Failures | Patients Deaths | |||
| aHR (95% CI) | P-value | aHR (95% CI) | P-value | |
| Pre-pandemic Era | Reference | Reference | ||
| Covid Negative | 1.07 (1.01, 1.12) | 0.012 | 1.17 (1.13, 1.23) | <0.001 |
| Covid Positive | 1.26 (1.10, 1.44) | 0.001 | 1.06 (0.93, 1.22) | 0.395 |
| Covid Unknown | 0.92 (0.82, 1.05) | 0.212 | 1.34 (1.22, 1.46) | <0.001 |
Funding
- Commercial Support – Dialysis Clinic, Inc.