Purpose: The utilization of kidney transplantation (KT) from donors with COVID-19 was limited due to the concern of inferior transplant outcomes.  This study aimed to determine the impact of kidneys from donors with COVID-19 on recipients’ 1-year eGFR after KT. 
Methods: We examined deceased donor KT recipients aged ≥18 years using data from Organ Procurement and Transplantation Network (OPTN) in the United States from 3/1/2020 and 10/31/2022. COVID-19 positive donors were stratified into resolved (defined as PCR test positive >1week from procurement) and active COVID-19 (defined as PCR positive ≤1week from procurement) and compared to COVID-19 negative donors. The associations of COVID-19 kidney status with recipients’ 1-year eGFR were estimated using multivariable inverse probability of treatment weighted (IPTW) analyses and weights generated by a multinomial logistic model. Additional two subgroup analyses were performed examining patients receiving COVID-19 kidneys from 1) donors with acute kidney injury (AKI vs no AKI) and 2) donor race (Non-Hispanic Black vs Non-Hispanic White) with the recipients' 1-year eGFR.
Results: Of the 21,957 recipients, 157 received kidneys from resolved COVID-19, 295 from active COVID-19, and 21,505 from COVID-19 negative donors. Compared to patients receiving kidneys from COVID-19 negative donors, recipients from active COVID-19 donors had statistically significant lower eGFR at 1 year (-2.30, p=0.048). Whereas the resolved was not statistically significant (-1.85, p=0.211). Among the recipients receiving kidneys from COVID-19 positive donors (active and resolved), recipients of kidneys from donors with AKI did not have statistically significant eGFR (-1.33, p=0.95) compared to without AKI. Among the recipients receiving kidneys from COVID-19 positive donors (active and resolved), recipients of kidneys from Non-Hispanic Black donors did not have statistically significant eGFR (-1.33, p=0.95) compared to Non-Hispanic White.
Conclusion: While we see a statistically significant decline in eGFR with active COVID-19 kidneys, the clinical difference is not remarkable. A similar kidney function is seen in subgroup analysis in AKI and AA donors. Kidneys from COVID-19 donors provide comparable outcomes of kidneys from negative COVID-19. This data encourages better utilization of these kidneys.