Long-term microvascular alterations in kidney transplant recipients after SARS-CoV-2 infection

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INTRODUCTION: Long‑term cardiovascular consequences of COVID‑19 in organ recipients have been insufficiently studied. OBJECTIVE: The aim of our study was to evaluate the association between COVID‑19 and microvascular abnormalities in kidney transplant recipients (KTRs) 8 weeks after SARS‑CoV‑2 infection. PATIENTS AND METHODS: The study population consisted of 54 KTRs, and was divided into 2 subgroups: patients with a history of COVID‑19 (n = 35) and patients without a history of COVID‑19 (n = 21). We assessed the structure and function of microcirculation in both groups. RESULTS: The mean (SD) age of the study group was 47.6 (12.7) years and 46% were men. The patients with and without a history of COVID‑19 did not differ in their baseline characteristics. As compared with the patients without a history of COVID‑19, those after SARS‑CoV‑2 infection had markedly lower median (interquartile range) values of ischemic response (IR) (IRmax, 7 [5-8.7] vs 9.6 [8.8-11.5]; P = 0.04; IR index 3.1 [2.3-4.2] vs 7.2 [5.2-8.2]; P = 0.01), with the IR index further confirmed in a multivariable analysis. A logistic regression analysis showed that estimated glomerular filtration rate was linked to microvascular functional decline, expressed by a poorer normoxia oscillatory index (odds ratio, 0.95; 95% CI, 0.9-0.99; P = 0.047). C‑reactive protein level was associated with arteriole wall thickness (R = 0.42; P = 0.02) and wall‑to‑lumen ratio (R = 0.48; P = 0.01). CONCLUSION: We documented that microvascular dysfunction in KTRs was associated with SARS‑CoV‑2 infection, and was detectable 8 weeks after its acute phase.

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