Health care systems worldwide have been facing major challenges since the outbreak of
the SARS-CoV-2 pandemic. Kidney transplantation (KT) has been tremendously affected due to
limited personal protective equipment (PPE) and intensive care unit (ICU) capacities. To provide
valid information on risk factors for ICU admission in a high-risk cohort of old kidney recipients from
old donors in the Eurotransplant Senior Program (ESP), we retrospectively conducted a bi-centric
analysis. Overall, 17 (16.2%) patients out of 105 KTs were admitted to the ICU. They had a lower
BMI, and both coronary artery disease (CAD) and hypertensive nephropathy were more frequent.
A risk model combining BMI, CAD and hypertensive nephropathy gained a sensitivity of 94.1% and a
negative predictive value of 97.8%, rendering it a valuable search test, but with low specificity (51.1%).
ICU admission also proved to be an excellent parameter identifying patients at risk for short patient
and graft survivals. Patients admitted to the ICU had shorter patient (1-year 57% vs. 90%) and graft
(5-year 49% vs. 77%) survival. To conclude, potential kidney recipients with a low BMI, CAD and
hypertensive nephropathy should only be transplanted in the ESP in times of SARS-CoV-2 pandemic
if the local health situation can provide sufficient ICU capacities