Prioritizing Kidney Transplantation During COVID-19: A Single-Center Experience and Lessons for Future Surge Planning

Background The COVID-19 pandemic disrupted elective surgical services, leading to the adoption of prioritization frameworks such as the Medically Necessary, Time-Sensitive (MeNTS) score. Cohort data from the initial pandemic year remains relevant when contextualized by later developments (vaccination rollout, targeted therapeutics, and recovery of transplant services). We evaluated case selection at the Cardiff Transplant Unit using MeNTS and early outcomes for patients considered for kidney transplantation during the first year of the pandemic. Methodology This single-center, retrospective, cohort study included adult patients considered for kidney transplantation between March 1, 2020, and March 1, 2021. MeNTS scores were calculated retrospectively for patients who received transplantation (n = 62) and those whose procedures were suspended (n = 45). Primary outcomes included early graft function and 90-day survival, one-year survival, and incidence/severity of COVID-19 infection. Results In total, 62 patients received transplantation, and 45 were suspended. The median cumulative MeNTS score was 58 (range = 52-64) in transplanted patients versus 61 (range = 57-65) in suspended patients (mean = 57.5 vs. 61.6; Mann-Whitney U = 401, Z = -6.269, p = 3.6 × 10^-10). One-year patient survival was high in both groups (transplanted, 96.7% vs. suspended, 97.8%). Delayed graft function occurred in 20/62 transplanted patients (32%); 5/62 (8.1%) subsequently developed graft failure. Overall, 14 patients (13% overall; nine transplanted, five suspended) acquired COVID-19 infection during follow-up. Of these patients, nine required hospitalization, three required intensive care, and one patient died. The median three-month estimated glomerular filtration rate among transplanted patients was 53 mL/minute/1.73 m² (range = 16-90). Conclusions During the first pandemic year, the Cardiff Transplant Unit prioritized patients with lower MeNTS scores and observed acceptable short-term patient and graft outcomes. While MeNTS provided a transparent triage framework, transplant-specific adaptation and prospective validation are needed to guide prioritization in future system shocks.