Background: The aim of our analysis was to evaluate the impact of the COVID-19 pandemic on the procurement program and kidney transplantation in Slovakia and to identify the risk factors for a severe course of COVID-19 disease, as well as the risk factors for COVID-19 fatalities, with focus on the parameters preceding the infection. Methods: 305 KTRs (68.8% males) with confirmed SARS-CoV-2 positivity were included in the multicentric retrospective analysis. Results: The procurement program and kidney transplants in Slovakia dropped in the observed period by 28.6% (P<0.0001) and by 33.5% (P<0.0001) respectively. Age over 59 years (OR=1.03, P=0.0088) and diabetes mellitus (OR=2.04, P=0.0106) were identified as independent risk factors for severe course of the disease. Risk factors for death were age over 59 years (OR=1.05, P=0.0003) and graft dysfunction with CKD-EPI<0.5 mL/s (OR=4.87, P=0.0029). The prevalence of the alpha variant in Slovakia was associated with a severe course in KTRs treated with corticoids (OR=5.72, P=0.0273) and in graft dysfunction with CKD-EPI<0.5 mL/s (OR=2.94, P=0.0076); the risk of death was higher in KTRs over 59 years (OR=1.07, P=0.0173) and again with CKD-EPI<0.5 mL/s (OR=4.42, P=0.0393). KTRs had a 3.7 times lower risk of infection compared to hemodialysis patients (14% vs 52%, P<0.0001), with mortality of 9.8% vs 30% (P<0.0001). Conclusion: The procurement and transplant program is sustainable even during a pandemic, provided that measures are set up quickly. Morbidity and mortality from COVID-19 in KTRs was comparable to the situation in EU countries.