*Purpose: To evaluate patient- and allograft-related outcomes following living and deceased donor kidney transplantation (KTx) in a unit operating at the epicentrum of the COVID-19 pandemic.

*Methods: Single-centre observational study comparing results of patients transplanted during the COVID-19 pandemic (SARS2-Tx group; 71#) with those remaining on the transplant waiting list (TWL) during the same period (SARS2-TWL group; 142#) or receiving a kidney in 2019 (CONTROL group; 75#) at the Ospedale Maggiore Policlinico, Milan, Italy. Data refer to latest follow-up available. Donor and recipient screening included: real-time reverse transcriptase polymerase chain reaction based molecular assay on nasal swab and BAL (at induction of anesthesia), serologic test, CRP, and chest high-resolution CT scan.

*Results: Demographic and clinical characteristics of the three groups were similar with an equivalent proportion of high immunological and surgical risk subjects. Patient survival was 98.6% in SARS2-Tx, 96% in CONTROL, and 97.2% in SARS2-TWL (P=ns) whereas death-censored transplant survival was 97% in SARS2-Tx and 96% in CONTROL (P=ns). There were 3 episodes of COVID-19 infection in SARS2-Tx (4.2%; 2 asymptomatic and 1 with moderate respiratory symptoms), 6 in CONTROL (8%; 5 asymptomatic and 1 fatal), and 3 in SARS2-TWL (97.9%; all fatal). The vast majority of COVID-19 infections were acquired during transplant-related hospital stay or dialysis sessions. Rejection rates before and during the pandemic were comparable (6% vs 4.2%; P=ns) reflecting the fact that we did not change our immunosuppression strategy. In fact, median tacrolimus C0 as well as MMF and steroid daily doses in SARS2-Tx and CONTROL were not significantly different at any time point of the study.

*Conclusions: Overall, our data seem to reassure centres worldwide willing to effectively continue their KTx program despite the COVID-19 crisis as no clinically relevant differences were observed among patients transplanted before and during the pandemic. The perceived increased risk of SARS-CoV-2 infection and virus-related death among patients remaining on dialysis further supports this point of view as long as strict and rigorous infection control strategies are embraced. A national multicentre study with larger population and longer follow-up is warranted to confirm these findings and help clinicians offer their patients adequate counselling.

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