Long-Term Decline in Renal Allograft Function After Severe COVID-19 in Kidney Transplant Recipients: Evidence From a Four-Year Retrospective Cohort Study

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-09-01 DOI:10.1016/j.transproceed.2025.06.012

Suzimar Silveira Rioja, Amanda Orlando Reis, Conrado Lysandro Rodrigues Gomes

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引用次数: 0

Abstract

Background

While coronavirus disease (COVID-19) has been extensively studied, long-term follow-up data in kidney transplant recipients (KTRs), particularly concerning the impact of severe COVID-19 on graft function, remain limited. This study provides critical evidence of sustained renal injury in KTRs with severe COVID-19, focusing on acute kidney injury (AKI) as a predictor of accelerated graft dysfunction over a 4-year follow-up period.

Methods

We conducted a retrospective cohort study of 43 KTRs hospitalized with COVID-19 in Brazil (April 2020 and July 2024). The survivors were followed up for a median of 2.5 years (range: 1.2–4.2 years). Longitudinal graft function was assessed using estimated glomerular filtration rate (eGFR) trajectories modeled with linear mixed-effects analysis.

Results

The in-hospital mortality rate was 37.2%. AKI occurred in 65.1% of patients and was more frequent among nonsurvivors (87.5% vs 51.9%, P < .05). Of the 13 patients requiring kidney replacement therapy, only 2 survived. Among the 27 survivors, we observed a significant decline in eGFR from 47.99 to 40.57 mL/min/1.73 m² (P = .032) in the follow-up period, driven by a steeper annual decline in those with AKI (−6.99 mL/min/1.73 · m² per year vs stable eGFR in non-AKI patients, P = .049). By the final follow-up, AKI survivors had a significantly lower eGFR than non-AKI patients (12.58 vs 47.57 mL/min/1.73 m², P = .003).

Conclusion

Severe COVID-19 has a lasting impact on graft function in KTRs, particularly in those with AKI. These findings underscore the importance of long-term nephrological surveillance and individualized post-COVID-19 management strategies for slowing graft dysfunction progression in this high-risk population.

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肾移植受者严重COVID-19后同种异体肾功能长期下降：来自四年回顾性队列研究的证据

背景：虽然冠状病毒病（COVID-19）已被广泛研究，但肾移植受者（KTRs）的长期随访数据，特别是关于严重COVID-19对移植物功能的影响的数据仍然有限。该研究提供了严重COVID-19的KTRs持续肾损伤的关键证据，重点关注急性肾损伤（AKI）作为4年随访期间加速移植物功能障碍的预测因子。方法：对巴西（2020年4月至2024年7月）43例因COVID-19住院的ktr患者进行回顾性队列研究。幸存者的随访中位数为2.5年（范围：1.2-4.2年）。纵向移植物功能评估使用估计肾小球滤过率（eGFR）轨迹建模与线性混合效应分析。结果：住院死亡率为37.2%。AKI发生率为65.1%，非幸存者发生率更高（87.5% vs 51.9%, P < 0.05）。在13例需要肾脏替代治疗的患者中，只有2例存活。在27名幸存者中，我们观察到eGFR在随访期间从47.99 mL/min/1.73 m²显著下降到40.57 mL/min/1.73 m²（P = 0.032），其中AKI患者的eGFR年下降幅度更大（-6.99 mL/min/1.73·m²/每年，而非AKI患者的eGFR稳定，P = 0.049）。到最后随访时，AKI幸存者的eGFR明显低于非AKI患者（12.58 vs 47.57 mL/min/1.73 m²，P = 0.003）。结论：严重的COVID-19对ktr患者，特别是AKI患者的移植物功能有持久的影响。这些发现强调了长期肾病监测和个性化的covid -19后管理策略对于减缓这一高危人群移植物功能障碍进展的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.