Purpose: This study aimed to assess changes in renal function during the acute disease and up to three months after the onset of symptoms among kidney transplant patients surviving COVID-19. Methods: This ongoing single-center observational prospective study included kidney transplant recipients diagnosed between March 2020 and May 2021 and survived the first 28 days. Before diagnosis, baseline renal function was defined as the mean of the last three creatinines. The follow-up period was three months. We used a one-way ANOVA test to compare the mean eGFR in baseline, 28 days, and three months after COVID-19. The CKD-EPI equation was used to estimate GFR. Results: Among the 787 patients, the mean age was 48.5 years, 59.3% were male, and 68.0% were white. Comorbidities such as hypertension, diabetes, and cardiopathy were present in 70.4%, 25.3%, and 3.9%, respectively. The mean body mass index was 26.9 kg/m², and baseline GFR was 51,9 ± 20.1 ml/min/1.73m². Immunosuppression was reduced by 27.1% and suspended in 9.5% of cases. In 30.3% of the patients, acute kidney injury occurred, 7.8% needed dialysis support, and 2.5% had graft loss. There was a decline in renal function at 28 days (50.0 ± 22.1 ml/min/1.73m²; p<0.001) and 3 months (47.3 ± 21.0 ml/min/1.73m²; p<0.001) after COVID-19. Among the patients, 47.3% did not return to baseline eGFR values within three months, and 19.9% reduced renal function at least 25%. Conclusions: COVID-19 does impact early renal function decline in KTR. These data reassure that KTR represents a group that benefits from early access to effective preventive strategies.

Purpose: This study aimed to investigate the clinical consequences three months after symptom onset among kidney transplant recipients surviving COVID-19. Methods: This is an ongoing single-center observational prospective study that includes adult kidney transplant recipients diagnosed and survived after COVID-19 between 03/20/2020 and 05/31/2021. Patients who lost their graft were excluded. The patients will receive a telephone at 3, 6, and 12 months after symptom onset from the clinical research team. The call consisted of a structured symptoms questionnaire with binary answers (yes or). The questionnaire included the following symptoms: headache, dizziness, anosmia/ageusia, weakness, myalgia, inappetence, diarrhea, and dyspnea, which could be presented before and/or after the COVID-19 diagnosis. Those patients with at least one symptom showed just after the disease was defined as having Long-COVID-19. Subsequently, the clinical research team included a question about the work status. Adjusted multivariable logistic regression models were used to identify the risk factors associated with Long-COVID-19. Results: There were 1,731 patients with COVID-19, with 455 deaths and 36 graft losses. Of the remaining 1,240 patients, 454 (36%) didn't answer our calls, yielding a final cohort of 786 patients. Of them, 217 (28%) developed Long-COVID-19. The incidence of each symptom at three months was: dyspnea (7%), myalgia (12%), weakness (11%), headache (10%), dizziness (7%), diarrhea (4%), inappetence (4%) and anosmia/ageusia (3%). About 1% of our patients needed domiciliary O2. Of those who obtained the functional status (n=239), 95 (40%) were employed before COVID-19, and 79 of them (83%) had returned to their original work at three months. After COVID-19 diagnosis, 44% of the patients were hospitalized (31% in ICU), 35% used supplemental O2, and 5% required mechanical ventilation. Fever (53%), shiver (39%), nausea (3%), anosmia/ageusia (59%), hospitalization (67%), and adverse cardiovascular events (3%), such as thrombosis or myocardial infarction, were risk factors associated with subsequent development of Long-COVID-19, using adjusted multivariable logistic regression. Conclusion:The incidence of Long-COVID-19 at three months was 28% and was associated with reduced quality of life and return to work. Several COVID-19 associated symptoms and disease severity markers were associated with Long-COVID-19.

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