Allograft function predicts mortality in kidney transplant recipients with severe COVID-19: a paradoxical risk factor

Area of Science:

• Nephrology
• Infectious Diseases
• Transplantation Immunology

Background:

• Kidney transplant recipients (KTRs) are vulnerable to severe COVID-19 due to immunosuppression.
• The impact of pre-existing allograft function on severe COVID-19 outcomes in KTRs remains understudied.

Purpose of the Study:

• To investigate the association between pre-infection allograft function and the prognosis of severe COVID-19 in kidney transplant recipients.

Main Methods:

• Retrospective cohort study of 82 KTRs with severe COVID-19.
• Patients categorized into decreased and normal estimated glomerular filtration rate (eGFR) groups based on pre-infection allograft function.
• Logistic regression and nomogram used to identify mortality risk factors.

Main Results:

• Higher mortality observed in KTRs with decreased pre-infection eGFR (31.25%) compared to normal eGFR (8.00%) (P=0.006).
• Pre-infection allograft insufficiency and high mycophenolic acid dosage (>1500 mg/day) were independent risk factors for death.
• Nirmatrelvir/ritonavir use showed a protective effect against mortality (OR=0.15).

Conclusions:

• Pre-infection allograft function is a significant predictor of mortality in KTRs with severe COVID-19.
• Allograft function improved post-treatment for severe COVID-19, unlike in non-severe cases.