ABSTRACT
Purpose: The number of kidney transplant (KT) was decreased since the COVID-19 pandemic;however, the magnitude of the pandemic on the number of U.S. KT is unclear. We aim to examine KT access in the United States over the past 2 years of the COVID-19 pandemic. Method(s): The number of U.S. kidney transplant recipients from 1988 to 11/28/21 among 48 States performing KT and confirmed COVID-19 cases and deaths were retrieved from OPTN/SRTR and CDC, respectively. The association of COVID-19 cases and deaths in 2020 and 2021 with the change in the number of KT were examined by linear regression. Interrupted time series defining the beginning of the pandemic in late 2019 as the time reflecting event change and Poisson regression were used to test the magnitude of KT decline since the beginning of pandemic. Result(s): The number of KT had generally trended up from 1988 until 2019 when it has trended down (23,401, 22,817, and 20,736 in 2019, 2020, and 2021, respectively). The number of COVID-19 cases increased from 19,759,635 in 2020 to 27,284,847 in 2021 and mean COVID-19 death rate increased (227 and 340 deaths/10,000 COVID- 19 cases;p 0.592). Compared to 2020, every 10,000 increased in COVID-19 cases in 2021 was associated with significant decrease in 18 KT;however, there was no significant association between the changes in COVID-19 deaths and KT between 2020 and 2021 (betacases 0.00018, p 0.005, 95%CI 0.00006, 0.00030 (Figure 1A) and betadeaths 0.00014, p 0.805, 95%CI -0.00098, 0.00126 (Figure 1B)). The number of KT after the COVID-19 pandemic is 1.43% lower than those before the pandemic (IRR 0.985, p 0.010, 95%CI 0.975, 0.997;Figure 2). Conclusion(s): Although ongoing COVID-19 pandemic over the past 2 years leads to increasing number of COVID-19 cases and deaths, only the number of COVID-19 cases, but not deaths, has significantly affected the number of KT in the United States.
ABSTRACT
Background: In the general population obesity is associated with increased risk of mortality. However, in ESKD patients obesity is associated with lower risk of mortality, particularly in dialysis patients (i.e. the obesity paradox). In COVID-19 patients, obesity exhibits a similar association with mortality as observed in the non-COVID-19 general population. Given the obesity paradox, we questioned the association of obesity with mortality in ESKD patients with COVID-19. Methods: Data from the European Renal Association COVID-19 Database (ERACODA) were analysed. Association of BMI (kg/m2), divided into: <18.5 (lean), 18.5-24.9 (normal weight), 25-29.9 (overweight), 30-34.9 (obese I) and ≥35 (obese II), with 3-month mortality was investigated using Cox proportional-hazards regression. Results were investigated for the total population and, dialysis patients and kidney transplant recipients separately. Results: In 3160 ESKD patients (mean age: 65 years, male: 61%), 99 patients were lean, 1151 normal weight (reference group), 1160 overweight, 525 obese I and 225 obese II. During follow-up of 3 months, 28%, 20%, 21%, 23% and 27% of patients died in the lean, normal weight, overweight, obese I and obese II category, respectively. In fully adjusted model, the HRs for 3-month mortality were 1.65 (95% CI:1.10, 2.47), 1.07 (95% CI:0.89, 1.28), 1.17 (95% CI:0.93, 1.46) and 1.71 (95%CI:1.27, 2.30) in lean, overweight, obese I and obese II vs normal weight patients (Figure). Results were similar among dialysis patients and transplant recipients (p-interaction=0.99). Conclusions: In ESKD patients with COVID-19, dialysis patients or kidney transplant recipients, obesity is associated with an increased risk of mortality at 3 months. This is contrary to obesity paradox generally observed in dialysis patients. There is need to investigate why in dialysis patients with COVID-19 the survival benefit of obesity is lost.
ABSTRACT
BACKGROUND AND AIMS: Coronavirus disease 19 (COVID-19) pandemic leads to poorer health outcomes and more utilizing of healthcare resources. Kidney transplant (KT) can lead to worsening transplant outcomes with COVID-19 and trend of KT in the United States decreases. Given a highly contagious disease, high population density may contribute to not only higher rate of the disease, but also lower rate of KT. We aim to examine the association of the number of COVID-19 cases and change in the number of KT with the interaction of population density in the United States. METHOD: A cross-sectional study was conducted by using publicly available data of COVID-19 cases and KT in the United States were retrieved from the Centers of Disease Control and Prevention (CDC) and the Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients (OPTN/SRTR), respectively. The association of the cumulative COVID-19 cases of 47 states in the United States where KT occurred between January 1, 20202 and January 6, 2021 with difference in the number of KT between year 2019 and 2020 (DKT) was examined by using multiple linear regression. RESULTS: During the study period, a total of 20,136,895 COVID-19 cases were detected in the United States and 326,535 patients died. From all 47 states, 23,002 and 20,554 adult KT were performed in 2019 and 2020, respectively. Mean COVID-19 cases and deaths were 428,445±457,344 and 6,948± 6,911, respectively among the 47 states. Mean ΔKT2019-2020 were 526 81. Every 10,000 COVID-19 cases was associated with a decrease in 1.06 KT in year 2020 compared to year 2019 (βcoeff 0.00011, p <0.0001, 95% CI 0.00006, 0.00015). However, after adjusted for the number of KT in 2019, COVID-19 cases (< or ≥ median cases of 317,545), population density (< or≥ median density of 114 people/mile2), and the interaction term between COVID-19 cases and population density, the states with high rate of COVID-19 (≥317,545 cases/ year) and high population density (≥114 people/mile2) had a decrease in 12.4 KT;whereas, there was 4.5 KT decrease in states with low COVID-19 rate and low population density (βcoeff 0.1024705, p 0.000, 95%CI 0.066272, 0.1386691, p interaction - 0.686). CONCLUSION: The number of KT in 2020 has decreased independent to the number of 2019 KT and population density. However, a decrease in the number of KT was lower in the states with low COVID-19 rate and low population density compared to those with high COVID-19 rate and high population density. Distribution of healthcare resources and utilization including KT in the states with low COVID-19 cases and low population density may be one of the strategies to continue KT, which is life-saving therapy and better survival benefit compared to being on dialysis in endstage kidney disease population with a high mortality risk.
ABSTRACT
Background: The number of kidney transplant (KT) in the United States (US) has decreased during COVID-19 pandemic;however, the magnitude of this impact is unclear. Methods: A period from January 5 to April 18, 2020 was divided into pre- and post- COVID-19 periods by assigning March 1, 2020 as the first day of the post-COVID-19 outbreak in the US. The number of waitlist candidates (WLC) and new KT every 7 days were obtained from OPTN/SRTR. An interrupted time series analysis was performed to examine an incidence rate ratio (IRR) between pre- and post-COVID-19 period by using multiple Poisson regression. Results: Compared to pre-COVID-19 period, the average number of new KT during post-COVID-19 period decreased (479±33 vs 318±119 cases/week, mean difference±SEM 161±44, 95%CI 67, 255). The number of WLC was relatively stable (mean±SD 65,937±959 cases/week);whereas, it decreased during post-COVID-19 period (61,759±2203 cases/week). Mean incidence rates (IR) of new KT during pre- and post-COVID-19 periods were 727±58 and 511±176 cases/105 WLC-week, respectively (Figure1). The IR of new KT during post-COVID-19 period was 29% lower than those during pre-COVID-19 period(IRR 0.71, 95%CI 1.96, 2.11) and each one additional week was associated with a 4% decrease in the new KT (IRR 0.96, 95%CI 2.60, 2.63). After adjusted by age group, transplant areas, and time-study period interaction term, the IR of new KT was 3% increase for every one more week during pre-COVID-19 period (IRR 1.03);whereas, there were 12% decrease for every one more week after March 1, 2020(IRR 0.88). Compared to pre-COVID-19 period, the IR of new KT during post- COVID-19 period was 9% lower for every additional week for each corresponding period (IRR 0.91). Conclusions: COVID-19 outbreak in the US since March 2020 is an independent factor of a significant decline in the number of new KT. Further information regarding ability of control COVID-19 may direct KT.