Increased Mortality in Kidney Transplant Recipients During the Delta/Omicron Era of the COVID-19 Pandemic Despite Widespread Vaccination

Clin Transplant. 2025 Jan;39(1):e70071. doi: 10.1111/ctr.70071.

Abstract

Introduction: The incidence of mortality late in the pandemic, particularly after widespread vaccine availability, is not well understood. Herein, we elucidate the effect of this impact of the COVID pandemic as well as risk factors for mortality during it.

Methods: The primary end point was death with a functioning graft with secondary endpoints of mortality rates in subgroups and at different time intervals during the pandemic.

Results: Despite widespread vaccination, mortality rates for kidney transplant (KTx) recipients almost doubled during the COVID-19 era (6.40 deaths per 100 person years vs. 3.54 pre-COVID). Mortality increased in all racial/ethnic groups but increased more in Native Americans, Hispanics, and African Americans compared to non-Hispanic Caucasians. The highest mortality rate occurred during the Delta and Omicron time frames. In contrast to the general population, mortality was more evenly spread across age groups in KTx recipients.

Conclusions: Mortality rates during the COVID-19 era were extremely high, more than doubling in some racial/ethnic groups. We conclude that the KTx population was a particularly vulnerable group during the COVID-19 era and suggests the need for further research into the management of variants in the future.

Keywords: ethnicity/race; infection and infectious agents; statistics.

MeSH terms

  • Adult
  • Aged
  • COVID-19 Vaccines / administration & dosage
  • COVID-19* / epidemiology
  • COVID-19* / mortality
  • COVID-19* / prevention & control
  • Female
  • Humans
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation* / mortality
  • Male
  • Middle Aged
  • Pandemics
  • Risk Factors
  • SARS-CoV-2*
  • Survival Rate
  • Transplant Recipients / statistics & numerical data
  • United States / epidemiology
  • Vaccination* / statistics & numerical data

Substances

  • COVID-19 Vaccines