Qiu Shawn, Hadidchi Roham, Vichare Aditi, Lu Justin Y, Hou Wei, Henry Sonya, Akalin Enver, Duong Tim Q
Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA.
Department of Medicine (Nephrology), Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA.
Diagnostics (Basel). 2025 Apr 25;15(9):1091. doi: 10.3390/diagnostics15091091.
Although kidney transplant recipients (KTRs) who are immune-compromised have been shown to be at high risk of adverse acute COVID-19 outcomes (i.e., mortality and critical illness), the long-term outcomes of KTRs with a history of SARS-CoV-2 infection are unknown. We aimed to compare long-term outcomes of KTRs with and without exposure to SARS-CoV-2. This study retrospectively evaluated 1815 KTRs in the Montefiore Health System from 4 January 2001 to 31 January 2024. The final cohorts consisted of KTRs who survived COVID-19 ( = 510) and matched KTRs without COVID-19 ( = 510, controls). Outcomes were defined as all-cause mortality and changes in estimated glomerular filtration rate (eGFR) and urine protein to creatinine ratio (UPCR) from 30 days up to four years post index date. Kaplan-Meier survival analysis and Cox proportional modeling were performed for mortality. Generalized estimating equations were used to analyze changes in eGFR and UPCR across time. There was no significant group difference in long-term all-cause mortality (adjusted hazard ratio = 0.66, [0.43, 1.01] = 0.057). eGFR in controls and COVID-19 patients before infection similarly decreased -0.98 units/year [-1.50, -0.46]. By contrast, eGFR declined at a significantly greater rate (-1.80 units/year [-2.45, -1.15]) in KTRs after COVID-19 compared to KTRs without COVID-19. This association was only seen among male and not female KTRs. COVID-19 status was not significantly associated with rate of change in UPCR or acute kidney rejection rate. SARS-CoV-2 infection was associated with an accelerated decline in eGFR up to four years post infection, suggesting potential long-term implications for graft health. These findings underscore the importance of vigilant monitoring and management of kidney function post SARS-CoV-2 infection in this vulnerable population.
尽管免疫功能低下的肾移植受者（KTRs）已被证明发生不良急性COVID-19结局（即死亡率和危重病）的风险很高，但有SARS-CoV-2感染史的KTRs的长期结局尚不清楚。我们旨在比较有和没有接触SARS-CoV-2的KTRs的长期结局。本研究回顾性评估了2001年1月4日至2024年1月31日期间蒙特菲奥里医疗系统中的1815名KTRs。最终队列包括从COVID-19中存活下来的KTRs（n = 510）和匹配的未感染COVID-19的KTRs（n = 510，对照组）。结局定义为全因死亡率以及从索引日期后30天至四年内估计肾小球滤过率（eGFR）和尿蛋白肌酐比（UPCR）的变化。对死亡率进行了Kaplan-Meier生存分析和Cox比例建模。使用广义估计方程分析eGFR和UPCR随时间的变化。长期全因死亡率无显著组间差异（调整后风险比 = 0.66，[0.43, 1.01]，P = 0.057）。对照组和感染前COVID-19患者的eGFR同样以每年-0.98单位[-1.50, -0.46]的速度下降。相比之下，与未感染COVID-19的KTRs相比，感染COVID-19后的KTRs中eGFR下降速度明显更快（-1.80单位/年[-2.45, -1.15]）。这种关联仅在男性KTRs中出现，而在女性KTRs中未出现。COVID-19状态与UPCR变化率或急性肾排斥率无显著关联。SARS-CoV-2感染与感染后长达四年的eGFR加速下降有关，提示对移植肾健康可能存在长期影响。这些发现强调了在这一脆弱人群中对SARS-CoV-2感染后肾功能进行密切监测和管理的重要性。
