Azvudine for COVID-19 in Kidney Transplant Recipients: A Real-World Observational Study of Long-Term Renal Outcomes

Objectives: Coronavirus disease 2019 (COVID-19) poses a significant threat to kidney transplant recipients (KTRs) due to chronic immunosuppression. While Azvudine has demonstrated antiviral efficacy, its long-term impact on allograft function in KTRs remains unknown. This single-arm retrospective study provides a comprehensive evaluation of the outcomes. Methods: This single-center, retrospective study consecutively enrolled 20 KTRs diagnosed with COVID-19 during the Omicron surge (December 2022-January 2023), all treated with an Azvudine-centered regimen. Clinical data, treatment responses, and serial renal function parameters were analyzed. Long-term follow-up extended to a median of 39 months. Results: The median time to COVID-19 nucleic acid negativity was 13.22 days. Renal function improved significantly during treatment: estimated glomerular filtration rate increased by a mean of 27.29 mL/min/1.73 m², and serum creatinine decreased by 57.72 µmol/L (both p < 0.01). Common complications included electrolyte imbalances and co-infections (50% of patients). Crucially, at a median follow-up of 39 months, 75% (15/20) of patients maintained normal allograft function. No Azvudine-related adverse events or drug interactions with immunosuppressants were observed. Conclusions: While acknowledging the inherent limitations of a non-comparative design, this study provides preliminary evidence suggesting that an Azvudine-centered regimen may be associated with promising efficacy, a favorable safety profile without interference with immunosuppressive therapy, and-most importantly-durable renal allograft survival in KTRs with COVID-19. Our data suggest that this regimen could contribute to mitigating the long-term risk of allograft dysfunction, potentially bringing outcomes closer to the expected baseline for stable recipients. Coupled with its low risk of drug-drug interactions, potential immunomodulatory benefits, and superior cost-effectiveness, Azvudine could be considered a valuable therapeutic option for this high-risk population in the post-pandemic era, although these findings warrant cautious interpretation. Controlled trials are ultimately needed to confirm these observations.