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Long-Term Decline in Renal Allograft Function After Severe COVID-19 in Kidney Transplant Recipients: Evidence From a

Suzimar Silveira Rioja1, Amanda Orlando Reis1, Conrado Lysandro Rodrigues Gomes1

  • 1Clinical and Academic Unit of Nephrology, Pedro Ernesto University Hospital, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil.

Transplantation Proceedings
|July 9, 2025
PubMed

Insights

Severe COVID-19 significantly harms kidney transplant recipients, causing lasting graft damage, especially in those with acute kidney injury. Long-term monitoring is crucial for managing declining kidney function in this vulnerable group.

Area of Science:

  • Nephrology
  • Transplantation
  • Infectious Diseases

Background:

  • Limited long-term data exists on severe COVID-19's impact on kidney transplant recipients (KTRs).
  • Severe COVID-19 can cause sustained renal injury, affecting graft function.
  • Acute kidney injury (AKI) is a key factor in accelerated graft dysfunction post-COVID-19.

Purpose of the Study:

  • To evaluate the long-term effects of severe COVID-19 on graft function in KTRs.
  • To assess the role of AKI as a predictor of graft dysfunction after severe COVID-19.
  • To analyze estimated glomerular filtration rate (eGFR) trajectories in KTRs post-COVID-19.

Main Methods:

  • Retrospective cohort study of 43 KTRs hospitalized with COVID-19.
  • Follow-up of survivors for a median of 2.5 years (range: 1.2-4.2 years).
  • Longitudinal graft function assessed via eGFR using linear mixed-effects modeling.

Main Results:

  • In-hospital mortality was 37.2%; AKI occurred in 65.1% of patients.
  • Survivors with AKI showed a significant eGFR decline over time (-6.99 mL/min/1.73 m²/year).
  • AKI survivors had significantly lower eGFR at final follow-up compared to non-AKI patients (12.58 vs 47.57 mL/min/1.73 m²).

Conclusions:

  • Severe COVID-19 leads to lasting graft dysfunction in KTRs, particularly those experiencing AKI.
  • AKI is a critical predictor of accelerated graft failure post-COVID-19.
  • Emphasizes the need for long-term nephrological surveillance and tailored management for KTRs post-COVID-19.
Abstract

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