Kidney transplantation is the optimal treatment for end-stage kidney disease, significantly enhancing patient longevity and quality of life. Despite its clinical importance, transplant services worldwide faced substantial disruptions due to the COVID-19 pandemic. This study provides a comprehensive analysis of kidney transplantation rates in Australia from 2004 to 2023, examining the profound effects of the pandemic on transplant activities and their recovery trajectory.

We conducted a retrospective analysis using transplantation data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), covering all kidney grafts performed in Australia from 2004 to 2023. Annual transplantation rates were calculated and standardised per million population using Australian Bureau of Statistics data, ensuring demographic changes were accurately reflected. Trends were compared between pre-pandemic (2004–2019), pandemic (2020–2021), and post-pandemic recovery periods (2022–2023).

Between 2004 and 2023, a total of 18,574 kidney transplants were performed in Australia. The overall transplantation rate significantly increased pre-pandemic, peaking at 45.36 per million in 2018. Following the onset of the COVID-19 pandemic, rates dramatically declined to a two-decade low of 33.36 per million in 2021, representing a 26.5% reduction from pre-pandemic peaks. However, the immediate post-pandemic years (2022–2023) demonstrated notable recovery, with transplantation rates rebounding to 40.84 per million by 2023. The number of living donor transplants also markedly decreased during the pandemic, with a modest recovery observed post-pandemic.

The COVID-19 pandemic caused unprecedented disruption in kidney transplantation activities in Australia, markedly reversing two decades of sustained progress. Although recent recovery trends are promising, rates have yet to return fully to pre-pandemic levels. These findings underscore the critical need for resilient healthcare strategies, optimised resource allocation, and enhanced contingency planning to safeguard transplantation services during future global health crises. Further targeted research is essential to guide policy adaptations and enhance systemic resilience.