Long-term microvascular alterations in kidney transplant recipients after SARS-CoV-2 infection

Long‑term cardiovascular consequences of COVID‑19 in organ recipients have been insufficiently studied.

The aim of our study was to evaluate the association between COVID‑19 and microvascular abnormalities in kidney transplant recipients (KTRs) 8 weeks after SARS‑CoV‑2 infection.

The study population consisted of 54 KTRs, and was divided into 2 subgroups: patients with a history of COVID‑19 (n = 35) and patients without a history of COVID‑19 (n = 21). We assessed the structure and function of microcirculation in both groups.

The mean (SD) age of the study group was 47.6 (12.7) years and 46% were men. The patients with and without a history of COVID‑19 did not differ in their baseline characteristics. As compared with the patients without a history of COVID‑19, those after SARS‑CoV‑2 infection had markedly lower median (interquartile range) values of ischemic response (IR) (IRmax, 7 [5-8.7] vs 9.6 [8.8-11.5]; P = 0.04; IR index 3.1 [2.3-4.2] vs 7.2 [5.2-8.2]; P = 0.01), with the IR index further confirmed in a multivariable analysis. A logistic regression analysis showed that estimated glomerular filtration rate was linked to microvascular functional decline, expressed by a poorer normoxia oscillatory index (odds ratio, 0.95; 95% CI, 0.9-0.99; P = 0.047). C‑reactive protein level was associated with arteriole wall thickness (R = 0.42; P = 0.02) and wall‑to‑lumen ratio (R = 0.48; P = 0.01).

We documented that microvascular dysfunction in KTRs was associated with SARS‑CoV‑2 infection, and was detectable 8 weeks after its acute phase.