Post-COVID-19 cardiovascular disease risk in kidney transplant recipients

Given the unique risk profile of kidney transplant recipients (KTRs), characterizing their cardiovascular disease (CVD) risk after COVID-19 remains critical for targeted management. We performed a retrospective analysis of 809 clinically diagnosed symptomatic COVID-19 events among 778 KTRs from a health system in Maryland (March 2020 to January 2024) to characterize incidence and risk factors of post-COVID-19 CVD. We followed KTRs until composite CVD (acute coronary syndrome, stroke, heart failure, and CVD-related death) occurrence, non-CVD-related death, or 1 year after COVID-19 and identified risk factors using least absolute shrinkage and selection operator-based subdistribution hazards regression. Incidence of post-COVID-19 CVD was 8.7% at 1 year (acute coronary syndrome, 2.7%; stroke, 1.4%; heart failure, 3.6%; and CVD-related death, 1.0%). KTRs with a CVD history had higher incidence than those without (19.1% vs 5.0%). Older age, Black race, Hispanic ethnicity, previous CVD, and COVID-19 hospitalization increased post-COVID-19 CVD risk; body mass index of >30 kg/m² and treatment with remdesivir decreased post-COVID-19 CVD risk. COVID-19 hospitalization conferred equivalent risk to previous CVD: incidence was 11.2% among KTRs with previous CVD but no hospitalization, 12.0% among KTRs with hospitalization but no previous CVD, 25.2% among KTRs with both, and 1.8% among KTRs with neither. Post-COVID-19 CVD risk was high among KTRs and hospitalization for COVID-19 was as important as having had a previous cardiovascular event.