*Purpose: The COVID 19 pandemic has posed new challenges to transplant centers. The impact has been detrimental on wait-listed ESKD patients, reducing their access to life saving kidney transplant and prolonging time on the waiting list. Waitlist status is an independent predictor of hospitalization among COVID-19 infected kidney transplant candidates and is associated with increased mortality as high as 34% in one center. In this study, we aim to characterize the impact of COVID-19 on patients waitlisted for kidney and pancreas transplant at our center.

*Methods: We performed a retrospective chart review of adult candidates waitlisted for kidney transplant at our center who tested positive for COVID-19. We reviewed baseline patient demographics and co-morbidities, severity of COVID-19 illness, hospitalization rate, and mortality.

*Results: 38 patients waitlisted for kidney transplant, simultaneous kidney-pancreas, pancreas transplant alone tested positive for COVID-19 between March and November 2020. Of these, 22 (71%) were listed for 1^st kidney transplant, 7 (13.4%) for SPK, 6 (15.8%) for 2^nd kidney transplant, 3 (7.9%) for pancreas transplant alone. COVID-19 waitlisted candidates had median age-47 years (20-75), 20 (52.6 %) males. 52.6% white, 18.4% Hispanic, 15.7% Asian, and 13% Black. Significant racial disparities were noted especially among the Hispanic population who account for only 3.4% of our waitlist candidates but seem to have increased predilection for COVID 19 infection. The vast majority 30 (78.9%) of COVID 19 waitlist patients are hypertensive; and 17 (44.7%) diabetic. 25 (65.8%) of patients were treated as outpatient, 10 (26.3%) required hospitalization and 3 (7.9%) died. Critically, of the 38, only 3 (2 pancreas waitlist; 1 kidney) have recovered sufficiently to be reactivated on the waitlist. Mean time has been 16.7 weeks (SE=2.7 weeks) (range 13-22 weeks).

*Conclusions: COVID19 infection has a significant impact on candidates waitlisted for kidney and pancreas transplantation. At our center, mortality has been 7.8%, hospitalization, 26.3%. But, to date, only 7.8% have been reactivated on the waitlist, predisposing them to increased morbidity and mortality.

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