TOPLINE

Early remdesivir treatment was associated with a 47% lower risk for all-cause graft loss and a 42% lower risk for cardiovascular events in kidney transplant recipients with COVID.

METHODOLOGY

• Researchers emulated a target trial using retrospective data from five hospitals within the Johns Hopkins Health System to compare outcomes between adult kidney transplant recipients diagnosed with symptomatic COVID from March 2020 to January 2024 who received early remdesivir and those who did not.
• Most patients had deceased donor grafts (63.2%); 25.2% had undergone transplantation within the prior year; 41.2% were unvaccinated, whereas 38.2% had received three or more vaccine doses; 58.8% paused antimetabolites; and 60.2% were infected during the Omicron wave.
• Of 432 adult kidney transplant recipients (median age, 57 years; 42.6% women) with functioning allografts diagnosed with symptomatic COVID, 177 received early remdesivir and 255 received no remdesivir. Early remdesivir was defined as treatment initiation within 7 days of the first positive SARS-CoV-2 test, with at least 3 consecutive days of therapy.
• The primary outcome was all-cause graft loss, a composite of graft failure and all-cause mortality; secondary outcomes included all-cause mortality, cardiovascular events, and long COVID.
• Participants were followed for up to 1 year after COVID diagnosis.

TAKEAWAY

• After adjustment, early remdesivir initiation vs no remdesivir was associated with a 47% lower risk for all-cause graft loss (hazard ratio [HR], 0.53) and a 42% lower risk for cardiovascular events (HR, 0.58).
• Early remdesivir initiation was not significantly associated with a lower risk for all-cause mortality or long COVID.
• The association between early remdesivir and reduced all-cause graft loss held across several subgroups, including patients younger than 65 years, those with obesity, recipients of deceased or living donor kidneys, patients with hypertension, and those without known coronary artery disease.

IN PRACTICE

“These findings support guideline recommendations for early antiviral therapy in high-risk populations and suggest that prompt initiation of remdesivir may protect both kidney allografts and cardiovascular health in [kidney transplant] recipients with COVID-19,” the authors of the study wrote.

SOURCE

The study was led by Karan Srisurapanont, MD, of the Johns Hopkins University School of Medicine in Baltimore, and Kasama Manothummetha, MD, of the University of Miami/Jackson Memorial Hospital in Miami. It was published online in JAMA Network Open.

LIMITATIONS

The study used medical records rather than data from a randomized trial, so unmeasured differences between groups could have influenced the results. Data came from a single health system, which may limit generalizability. The long COVID analysis included few events and had wide uncertainty, so the lack of a significant association should be considered inconclusive.

DISCLOSURES

Some authors disclosed receiving grants, personal fees, and consulting fees and serving on advisory boards for various companies outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.