Nitipong Permpalung said early remdesivir was linked to better 1-year outcomes for kidney transplant recipients with COVID, with treatment started within 7 days of diagnosis tied to a lower risk of graft failure or death. The findings appeared in JAMA Network Open and came from 432 patients treated across five hospitals in the Johns Hopkins Health System.
Permpalung said, “The main message for clinicians is to act early,” and added that “When a kidney transplant recipient develops COVID-19 symptoms or tests positive, the patient should contact the transplant team promptly, and antiviral treatment should be considered before the illness becomes severe.”
JAMA Network Open
The retrospective target trial emulation study used clone-censor-weight adjustment and covered data from March 2020 through January 2024. All 432 patients had a functioning allograft, the median age was 57 years, and 57.4% were male. Forty-one percent initiated early remdesivir within 7 days of diagnosis and received at least 3 consecutive days of therapy; the rest received no remdesivir.
Early remdesivir was associated with a 47% lower risk of graft failure or death at 1 year, with an HR of 0.53 and a 95% CI of 0.31-0.92. It was also associated with a 42% lower risk of cardiovascular events, with an HR of 0.58 and a 95% CI of 0.35-0.98.
Johns Hopkins University School of Medicine
Permpalung, who is at Johns Hopkins University School of Medicine, said the results fit the CDC’s advice to start antiviral therapy early in patients at high risk of COVID progression. He also noted that many prior trials excluded patients with severe kidney impairment and transplant recipients, leaving limited trial evidence for this group.
The same study also points to the practical constraint behind the finding: remdesivir use in kidney transplant recipients has raised concerns about nephrotoxic effects and drug-drug interactions with immunosuppressive agents like tacrolimus. Permpalung said, “However, our findings do not mean that every kidney transplant recipient should automatically receive remdesivir,” and added that treatment should be individualized based on timing of infection, clinical risk, drug interactions, safety, preferences, and access to treatment.
Baltimore
He also said, “Prevention and treatment should be viewed as complementary,” and added, “Vaccination remains the first layer of protection, but kidney transplant recipients may still have breakthrough infections because of their immunosuppression.” Permpalung said, “When infection occurs, there should already be a plan for rapid testing, contacting the transplant team, and accessing antiviral treatment.”
The study strengthens the case for early action after symptoms or a positive test, but it does not turn remdesivir into a blanket approach for every kidney transplant recipient. The immediate takeaway is to move fast, involve the transplant team, and match treatment to the patient rather than the diagnosis alone.
