Post-COVID-19 Cardiovascular Risk in Kidney Transplant Recipients.

Publication date: Jul 15, 2025

Given the unique risk profile of kidney transplant recipients (KTRs), characterizing their cardiovascular disease (CVD) risk after COVID-19 remains critical for targeted management. We performed a retrospective analysis of 809 clinically diagnosed symptomatic COVID-19 events among 778 KTRs from one Maryland health system (3/2020-1/2024) to characterize incidence and risk factors of post-COVID-19 CVD. We followed KTRs until composite CVD (acute coronary syndrome (ACS), stroke, heart failure (HF), CVD death), non-CVD death, or one year after COVID-19 and identified risk factors using LASSO-based sub-distribution hazards regression. Incidence of post-COVID CVD was 8. 7% at one-year (2. 7% ACS, 1. 4% stroke, 3. 6% HF, and 1. 0% CVD death). KTRs with CVD history had higher incidence than those without (19. 1% vs 5. 0%). Older age, Black race, Hispanic ethnicity, prior CVD, and COVID-19 hospitalization increased post-COVID CVD risk; BMI>30 and treatment with remdesivir decreased post-COVID CVD risk. COVID-19 hospitalization conferred equivalent risk to prior CVD: incidence was 11. 2% among KTRs with prior CVD but no hospitalization, 12. 0% among KTRs with hospitalization but no prior CVD, 25. 2% among KTRs with both, and 1. 8% among KTRs with neither. Post-COVID-19 CVD risk was high among KTRs and hospitalization for COVID-19 was as important as having had a prior cardiovascular event.

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