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

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.