*Purpose: Mortality secondary to COVID-19 infection is significantly higher in solid organ transplant recipients compared to the general population. Limited data exists evaluating the impact COVID has had on mortality compared to other causes, with even less data specific to the Mountain West region of the United States. This quality improvement project seeks to evaluate trends in patient mortality at a center in the Mountain West region before and after the COVID pandemic in kidney transplant recipients (KTR).

*Methods: This is a retrospective single-center analysis of all adult KTRs who underwent transplant between January 1999 and July 2021 and subsequently died between January 2015 and July 2021, assessing the change in mortality trends with the advent of the COVID-19 pandemic. Additional endpoints include time from transplant to death, graft status at time of death, and COVID vaccination status. Data collection included UNOS data reports as well as manual electronic medical record review.

*Results: One-hundred and seventy-two KTRs were included with baseline characteristics described in Table 1. Prior to the COVID-19 pandemic, the most common etiology of mortality was cardiovascular cause with a median of 18% mortality (see Table 1). Of those who died in 2020, 33% were secondary to COVID-19 leading to a 174% increase in cumulative patient deaths compared to the year prior (23 vs 40 patient deaths in 2019 vs 2020; see Table 1 and Figure 1). Of those who died secondary to COVID, none had received the COVID-19 vaccine.

*Conclusions: COVID-19 pneumonia and its associated complications have led to an increase in and earlier mortality prior to vaccination implementation, changing the mortality landscape in KTRs. Further investigation is needed to elucidate non-COVID related changes in mortality and patient outcomes in the ongoing COVID pandemic.

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