Impact of the kidney transplantation moratorium in France because of the COVID-19 pandemic: Vincent Bonnemains

BACKGROUND: The COVID-19 pandemic has resulted in worldwide kidney transplantation (KT) moratoriums. The impacts of these moratoriums on the life expectancy of KT candidates remain unclear. METHODS: We simulated the evolution of several French candidate populations for KT using a multistate semi-Markovian approach and according to moratorium durations ranging from 0 to 24 months. The transition rates were modeled from the 63,927 French patients who began dialysis or were registered on the waiting list for KT between 2011 and 2019. RESULTS: Among the 8,350 patients active on the waiting list at the time of the French KT moratorium decided on March 16, 2020, for 2.5-months, we predicted 4.0 additional months [CI: 2.8, 5.0] on the waiting list and 42 additional deaths [CI: -70, 150] up to March 16, 2030. In this population, we reported a significant impact for a 9-month moratorium duration: 135 attributable deaths [CI: 31, 257] up to March 16, 2030. Patients who became active on the list after March 2020 were less impacted. INTERPRETATION: The temporary moratorium of KT during a COVID-19 peak in order to free up hospitals’ resources doesn't impact patients’ 10-year survival if the moratorium does not exceed a prolonged period. Funding. French National Research Agency (ANR-20-COV8-0002-01). KEY MESSAGES: The French 2020 KT moratorium didn't impair patients’ 10-years survival. 9-month or longer moratoriums may impair patients’ 10-years survival.