ABSTRACT
Purpose: The COVID-19 pandemic poses a unique challenge for immunosuppression patients following kidney transplantation. Studies involving a single center or few centers have suggested that kidney transplant recipients generally have multiple other co-morbidities, such as diabetes and obesity, and are at high risk of developing the COVID-19 disease and mortality. This study aims to evaluate the nationwide impact of COVID-19 on mortalities in kidney transplant recipients. Methods: The UNOS database was queried for kidney transplant recipient deaths in the year 2020, where cause of death was known or specified. The final sample consisted of 1804 patients who died this year. Percentages of deaths caused by COVID-19 in the kidney transplant population were graphed by month from January to September and mapped by UNOS region. Risk factors associated with deaths caused by COVID-19 that were found to be significant in a univariate logistic regression analysis were then entered into a multivariate logistic regression analysis to determine odds ratios (OR). Statistical significance was determined at α=0.05. STATA Version 13.0 and R were used for this analysis. Results: After adjusting for over 30 covariates, UNOS region 9 was associated with significantly increased risk (O.R: 5.93 [4.23 - 8.29]) for deaths in kidney transplant recipients caused by COVID-19. The distribution of percentages of deaths caused by COVID-19 across the 11 UNOS regions is shown in Figure 1. A BMI ≥ 30 (O.R: 1.70 [1.24 - 2.33]), African American ethnicity (O.R: 2.92 [2.15 - 3.97]), Hispanic ethnicity (O.R: 3.65 [2.55 - 5.23]), and functional status of 90% at follow-up (O.R: 2.21 [1.07 - 4.58]) were associated with increased risk for death caused by COVID-19 in a kidney transplant recipient. Age ≥ 65yrs (O.R: 0.59 [0.44 - 0.79]) was associated with decreased risk for death caused by COVID-19 in a kidney transplant recipient. Conclusions: These results are consistent with the accelerated increase health disparities caused by COVID-19. Obese patients who had a kidney transplant tend to be at a higher risk because of multiple co-morbidities. Additionally, patients who have a higher functional status and are thus more active may be more likely to get exposed to COVID-19 while on immunosuppression. In contrast, the elderly who are under immunosuppression may be more likely to remain at home and limit exposure to COVID-19.