Introduction: COVID-19 infection and vaccination can impact the immune system of kidney transplant patients in various ways, raising concerns about potential graft vulnerability. In this observational study, we compared the incidence of graft dysfunction before, during, and after the COVID-19 pandemic to assess whether the pandemic has increased vulnerability to graft injury due to incidental viral infections.
Methods: All post-transplant follow-up cases were divided into three groups: Group I, followed up from 2010 to 2019; Group II, followed up from 2019 to 2022; and Group III, followed up from January 2022 to March 2024. Data on graft dysfunction due to viruses were compared among the three groups.
Results: Group I included 275 patients, Group II had 301 patients, and Group III had 350 patients. The incidence of CMV viremia was 3% in Group I, 18% in Group II, and 5% in Group III. Herpes Zoster occurred in 1% of Group I, 3% of Group II, and 2% of Group III. SARS-CoV-3 was absent in Group I, present in 15% of Group II, and absent in Group III. Adenovirus was positive in 8% of Group III, while Parvo B19 was present in 2% of Group III. HSV incidence was 1%. Renal biopsy revealed TMA in 19 patients in Group III, 6 in Group II, and one in Group I. Death due to viral infection was absent in Group I, 19 in Group II, and 6 in Group III. Graft failure occurred in 1 patient in Group I, 19 in Group II, and 3 in Group III. Although the overall incidence of viral infection was high during the COVID-19 epidemic, including deaths, the post-COVID-19 epidemic showed a higher incidence of TMA-related graft loss and death compared to Group I in the pre-COVID-19 era.
Conclusion: Post-COVID-19, we observed a higher incidence of TMA-related graft dysfunction due to viral infections. Further study and caution are needed as management for TMA is currently limited, and early intervention is recommended.