How Slovak Kidney Transplant Program Worked and How COVID-19 Crisis
Influenced Kidney Transplant Recipients in Slovakia
Abstract
Background: The aim of our analysis was to evaluate the impact of the
COVID-19 pandemic on the procurement program and kidney transplantation
in Slovakia and to identify the risk factors for a severe course of
COVID-19 disease, as well as the risk factors for COVID-19 fatalities,
with focus on the parameters preceding the infection. Methods: 305 KTRs
(68.8% males) with confirmed SARS-CoV-2 positivity were included in the
multicentric retrospective analysis. Results: The procurement program
and kidney transplants in Slovakia dropped in the observed period by
28.6% (P<0.0001) and by 33.5% (P<0.0001)
respectively. Age over 59 years (OR=1.03, P=0.0088) and diabetes
mellitus (OR=2.04, P=0.0106) were identified as independent risk factors
for severe course of the disease. Risk factors for death were age over
59 years (OR=1.05, P=0.0003) and graft dysfunction with
CKD-EPI<0.5 mL/s (OR=4.87, P=0.0029). The prevalence of the
alpha variant in Slovakia was associated with a severe course in KTRs
treated with corticoids (OR=5.72, P=0.0273) and in graft dysfunction
with CKD-EPI<0.5 mL/s (OR=2.94, P=0.0076); the risk of death
was higher in KTRs over 59 years (OR=1.07, P=0.0173) and again with
CKD-EPI<0.5 mL/s (OR=4.42, P=0.0393). KTRs had a 3.7 times
lower risk of infection compared to hemodialysis patients (14% vs 52%,
P<0.0001), with mortality of 9.8% vs 30%
(P<0.0001). Conclusion: The procurement and transplant program
is sustainable even during a pandemic, provided that measures are set up
quickly. Morbidity and mortality from COVID-19 in KTRs was comparable to
the situation in EU countries.