Late Effect of Early Phase COVID-19 on Outcomes of Kidney Transplant Recipients Who Survived the Acute Infection

The COVID-19 pandemic has significantly affected global health, particularly among high-risk populations such as kidney transplant recipients, who have exhibited elevated morbidity and mortality rates. Long-term effects of COVID-19 in kidney transplant recipients who survived the infection are unknown. We evaluated the long-term effects of early phase COVID-19 on patient and graft survival, as well as graft function, in kidney transplant recipients who survived the acute phase of the COVID-19 infection.

We conducted a prospective, single-center cohort study involving kidney transplant recipients who survived COVID-19 from June 2020 to January 2022. Patients were stratified by disease severity and followed for 24 months. Data on renal function (estimated glomerular filtration rate and urinary protein-to-creatinine ratio) were collected at multiple time points. Statistical analyses were based on χ2 tests, analysis of variance, generalized additive mixed models, and Kaplan-Meier analyses.

Among 1477 kidney transplant recipients, 233 (15.8%) contracted COVID-19, with 60 (25.8%) fatalities. Of the 173 survivors, 50 (28.9%) had mild, 102 (59%) moderate, and 21 (12.1%) severe disease. Severe cases showed significant declines in estimated glomerular filtration rate and higher rates of renal replacement therapy and acute rejection versus mild and moderate cases. Mean loss of glomerular filtration rate in 2 years among patients with severe COVID was 9 mL/min/m2. Graft and patient survival rates were also worse in moderate and severe COVID groups.

Kidney transplant recipients with mode-rate and severe COVID-19 experienced significant long-term declines in renal function and increased graft loss and mortality. Understanding these effects is critical for optimizing care for this population.