During the COVID-19 pandemic, kidney transplant candidates and recipients in the United States had high rates of death from the infection and its sequelae, according to new nationwide registry data from the United Network for Organ Sharing.

“This is the first analysis of national level COVID-19-related mortality in transplant recipients and patients waitlisted for a kidney transplant,” Sumit Mohan, MD, PhD, of the Columbia University Vagelos College of Physicians and Surgeons in New York, New York, stated in a press release from the American Society of Nephrology. “There was a large increase in deaths among these susceptible individuals, with a disproportionate impact on minorities.”

Of 134,948 patients on the kidney transplant waitlist in 2020, a total of 4774 died, including 516 (11%) from COVID-19-related causes, Dr Mohan and colleagues reported in the Clinical Journal of the American Society of Nephrology. The investigators found that a greater proportion of male waitlist candidates died from COVID-19 than from other causes (72% vs 65%) and at a higher rate compared with the same period in 2019 (63%). Black (34% vs 31%) and Hispanic (37% vs 19%) candidates had higher death rates from COVID-19 compared with other causes. Obese candidates (body mass index of 30 kg/m2 or higher) also had a higher death rate from COVID-19 (53% vs 45%).

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Among 190,481 kidney transplant recipients in 2020, a total of 5435 died, including 893 (16%) from COVID-19-related causes, the investigators reported. Recipients who died from COVID-19 were younger than recipients who died from other causes (median age 65 vs 68 years).

Black and Hispanic recipients in 2020 also had a disproportionate burden of COVID-19 deaths compared with non-COVID deaths and all deaths in 2019 (31% vs 25% vs 24%, respectively, for Black recipients and 31% vs 13% vs 11%, respectively, for Hispanic recipients).

Obese recipients likewise died at a higher rate from COVID-19: 44% vs 36% vs 36%, respectively.

Across cohorts, the majority of people who died from COVID-19 or other causes had a high school education or less. Diabetes affected significantly more candidates (69% vs 66%) and recipients (52% vs 49%) who died from COVID-19 compared with other causes. The investigators also found a geographic disparity in deaths. For example, 21% and 19% of COVID-19-related deaths among candidates and recipients, respectively, occurred in Organ Procurement and Transplantation Network (OPTN) Region 9 (New York and western Vermont) whereas 5% and 4% of deaths, respectively, occurred in OPTN Region 1 (Connecticut, Eastern Vermont, Maine, Massachusetts, New Hampshire, and Rhode Island).

Dr Mohan’s team found that the all-cause mortality rate in 2020 was higher among waitlisted candidates (24%) than among kidney transplant recipients (20%) compared with 2019.

“While 11% of deaths on the waitlist in 2020 were attributed to COVID-19, the remainder of the difference in mortality observed is also likely to be COVID-19 related to the extent that the pandemic has adversely impacted access to and delivery of healthcare, particularly during the peak of the initial surge,” according to the investigators. They suggested that waitlisted candidates who continued to receive in-center dialysis likely had less social distancing and greater chances of exposure to SARS CoV-2 compared with transplant recipients.

“The excess risk of COVID-19 mortality for both candidates and recipients may alter the amount of benefit associated with transplantation and impact clinical decision-making,” Dr Mohan’s team stated.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Mohan S, King K, Ali Husain S, Schold J. COVID-19-associated mortality among kidney transplant recipients and candidates in the United States. Clin J Am Soc Nephrol. Published online September 29, 2021. doi:10.2215/CJN.02690221

Study reveals high burden of COVD-19–related deaths among kidney transplant recipients and patients with kidney failure [press release]. American Society of Nephrology; September 29, 2021.