Ji Yisheng, Fei Shuang, Ji Hongsheng, OuYang Fan, Ding Runmin, Sun Li, Chen Hao, Ju Xiaobing, Tao Jun, Han Zhijian, Du Mulong, Wang Zijie, Tan Ruoyun, Gu Min
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
The First Clinical Medical College, Nanjing Medical University, Nanjing, China.
Kidney Dis (Basel). 2025 Feb 12;11(1):128-142. doi: 10.1159/000543935. eCollection 2025 Jan-Dec.
The aim of the study was to investigate the long-term effects of the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection and novel coronavirus disease (COVID-19) on prognosis of kidney transplant recipients.
A 1-year retrospective study was carried out among 362 domestic kidney transplant recipients who were divided into observational (COVID-19) and control groups. Stratification analysis was then carried out to investigate whether repeated infections and infection severity could influence graft prognosis. Kaplan-Meier curves assessed 1-year graft survival, while one-way analysis of variance (ANOVA) compared graft function and laboratory parameters. Generalized estimating equations and repeated-measures ANOVA confirmed the magnitude of the impact of COVID-19 on kidney grafts. Generalized logistic regression and Cox regression established a model for analyzing COVID-19 risk factors. Meta-analysis and subgroup analysis were performed for validation.
Exposure of COVID-19 had a significant effect on graft function within 1 year ( < 0.001), and this kind of effect was mostly brought by severer infections in the stratification analysis regarding graft survival rate ( < 0.001), estimated glomerular filtration rate (eGFR) level ( < 0.001), and 1-year eGFR slope ( = 0.014). Diagnostic model showed tacrolimus patients are less likely to get severe COVID-19 than cyclosporine ( = 0.004). Hyperglycemia ( = 0.004) and low hemoglobin ( = 0.023) are adverse factors for severe pneumonia. Hemoptysis, hypo-lymphopenia, high procalcitonin and ferritin are linked to poor allograft outcomes with SARS-CoV-2 infection.
COVID-19 severity is linked to poor kidney allograft prognosis. Hyperglycemia, low hemoglobin, and drug protocols including cyclosporine rather than tacrolimus are correlated with COVID-19 pneumonia. Hemoptysis, low lymphocytes, high procalcitonin or ferritin were concerned with kidney allograft prognosis post-COVID-19.
本研究旨在调查新型严重急性呼吸综合征冠状病毒（SARS-CoV-2）感染和新型冠状病毒病（COVID-19）对肾移植受者预后的长期影响。
对362名国内肾移植受者进行了为期1年的回顾性研究，这些受者被分为观察组（COVID-19）和对照组。然后进行分层分析，以调查重复感染和感染严重程度是否会影响移植肾预后。Kaplan-Meier曲线评估1年移植肾存活率，而单因素方差分析（ANOVA）比较移植肾功能和实验室参数。广义估计方程和重复测量方差分析确定了COVID-19对移植肾影响的程度。广义逻辑回归和Cox回归建立了分析COVID-19危险因素的模型。进行荟萃分析和亚组分析以进行验证。
COVID-19暴露在1年内对移植肾功能有显著影响（<0.001），在关于移植肾存活率（<0.001）、估计肾小球滤过率（eGFR）水平（<0.001）和1年eGFR斜率（=0.014）的分层分析中，这种影响主要由更严重的感染引起。诊断模型显示，使用他克莫司的患者比使用环孢素的患者患重症COVID-19的可能性更小（=0.004）。高血糖（=0.004）和低血红蛋白（=0.023）是重症肺炎的不利因素。咯血、淋巴细胞减少、降钙素原和铁蛋白升高与SARS-CoV-2感染后的移植肾不良结局有关。
COVID-
