Burden of adverse transplant outcomes in kidney transplant recipients with COVID-19 and invasive fungal infections: a retrospective cohort study

Invasive fungal infections (IFI) are a serious complication in kidney transplant recipients (KTR), leading to increased mortality and allograft failure. Common respiratory viral infections, such as COVID-19, are associated with IFIs, which might compound adverse transplant outcomes. This retrospective cohort study examined adult KTRs transplanted at Johns Hopkins from 2012 to 2018 with follow up through 2023. The association of COVID-19 hospitalization and IFI exposure with all-cause graft loss (ACGL) was assessed using a stochastic extension stratification method followed by Cox regression. Of 1453 KTRs, 440 experienced at least one COVID-19-associated hospitalization. COVID-19 hospitalization was associated with a 2.54-times greater risk of ACGL (95% CI, 1.78–4.31, p < 0.001) compared to matched KTRs without COVID-19-associated hospitalization. Of 16 KTRs with COVID-19- and IFI-associated hospitalizations, the risk of ACGL was 6.47-times higher (95% CI 1.53–27.26, p = 0.010) as compared to matched KTRs with COVID-19-associated hospitalization, alone. COVID-19-associated hospitalization increased risk of ACGL, which was further elevated in those with a history of IFI. These results highlight the continued need for preventative measures, particularly targeted against SARS-CoV2, to improve transplant outcomes in this high-risk population.