Adults with kidney transplants who were treated for COVID-19 with remdesivir within a week of diagnosis and received at least three consecutive days of therapy were less likely to experience cardiovascular or kidney problems up to a year later compared to those who did not receive the antiviral, according to findings from a target trial emulation study published in JAMA Network Open on Jul. 28.
Permpalung said that physicians consider many factors when treating COVID-19 in kidney transplant recipients, including immune function, kidney health, use of immune-suppressing therapies, drug interactions, treatment side effects, and the timing and severity of COVID-19. The short-term benefits of antivirals for patients at increased risk for severe outcomes have been established; however, this study is one of the largest to provide data on long-term outcomes for adult kidney transplant recipients—a group often excluded from randomized trials due to underlying risks.
The investigators identified adult kidney transplant recipients diagnosed with COVID-19 between March 2020 and January 2024 who received care at one of five Johns Hopkins Medicine hospitals in Maryland. Among 432 adults included in the analysis, 177 (41%) received at least a three-day course of intravenous remdesivir within a week of diagnosis while 255 (59%) did not receive remdesivir. Patients who received other therapies such as monoclonal antibodies or other antivirals were excluded.
Participants were divided into two groups based on whether they received remdesivir. All patients were followed for up to a year. The main outcome assessed was all-cause graft loss—defined as graft failure or death from any cause—with secondary outcomes including cardiovascular complications, death from any cause, and long COVID. Of all participants, 48 (11%) experienced all-cause graft loss; 43 (10%) had cardiovascular complications such as heart attack or stroke; death occurred in 35 patients (8%); and long COVID was reported by 17 patients (4%).
After adjusting for variables such as age, underlying health conditions, medications used, disease severity, time since transplantation, vaccination status against COVID-19, and timing of infection diagnosis among others—the researchers found early remdesivir treatment was associated with a 47% lower risk of all-cause graft loss and a 42% lower risk of cardiovascular events compared to no remdesivir. No significant associations were found regarding reduced risk of death from any cause or conclusive findings about long COVID due to limited documented cases.
Karan Srisurapanont said, "Several biologically plausible mechanisms may explain the observed associations. Early suppression of viral replication may reduce systemic inflammation, endothelial injury or damage to blood vessels, and thrombotic complications, or those related to severe blood clotting that may contribute to heart and kidney problems." Additional authors include Kasama Manothummetha, Nirada Siriyakorn, Mary Bowring, Lucy Li, Willa Cochran, Cory Schulz, Sean Ellis, Kanin Thammavaranucupt, Daniel Brennan, Robin Avery, and William Werbel.
