Impact of the Kidney Transplantation Moratorium in France Because of the COVID-19 Pandemic: A Cohort-Based Study

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 20 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.Findings: 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: 2.9, 5.1] on the waiting list and 45 additional deaths [CI: -52, 142] up to March 16, 2030. In this population, we reported a significant impact for a 9-month moratorium duration: 139 attributable deaths [CI: 44, 260] up to March 16, 2030. The other populations of patients who became active on the list after March 2020 were less impacted.Interpretation: The temporary moratorium of KT during a COVID-19 peak represents an acceptable decision to free up hospitals’ resources if the moratorium does not exceed a prolonged period.Funding Information: This work was supported by a public grant overseen by the French National Research Agency (ANR-20-COV8-0002-01).Declaration of Interests: The authors declared no conflict of interest for this study.Ethics Approval Statement: he study was approved by the REIN-registry Scientific Council (Project KiT-COVID 01-07-2020). It was performed in accordance with the Helsinki Declaration. The data collection was approved by the National Commission for Data Protection and Liberties (Comit  National de l’Informatique et des Libert s, CNIL, No. 180092587).