Supplementary Material for: A cohort study of the long-term influences of SARS-CoV-2 on kidney allograft outcomes in Chinese recipients: 1-year follow-up experience

Introduction: To investigate the long-term effects of the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection and novel coronavirus disease (COVID-19) on prognosis of kidney transplant recipients.
Methods: A 1-year retrospective study was carried out among 362 domestic kidney transplant recipients who were divided into observational (COVID-19) and control groups. Stratification analysis was then carried out to investigate whether repeated infections and infection severity could influence graft prognosis. Kaplan-Meier curves assessed 1-year graft survival, while one-way analysis of variance (ANOVA) compared graft function and laboratory parameters. Generalized estimating equations and repeated measures ANOVA confirmed the magnitude of the impact of COVID-19 on kidney grafts. Generalized logistic regression and Cox regression established a model for analyzing COVID-19 risk factors. Meta-analysis and subgroup analysis were performed for validation.
Results: Exposure of COVID-19 had a significant effect on graft function within 1 year (P<0.001), and this kind of effect was mostly brought by severer infections in the stratification analysis regarding graft survival rate (P<0.001), estimated glomerular filtration rate (eGFR) level (P<0.001), and 1-year eGFR slope (P=0.014). Diagnostic model showed tacrolimus patients less likely to get severe COVID-19 than cyclosporine (P=0.004). Hyperglycemia (P=0.004) and low hemoglobin (P=0.023) adverse for severe pneumonia. Hemoptysis, hypo lymphopenia, high procalcitonin, and ferritin linked to poor allograft outcomes with SARS-CoV-2 infection.
Conclusions: COVID-19 severity linked to poor kidney allograft prognosis. Hyperglycemia, low hemoglobin, and drug protocols including cyclosporine rather than tacrolimus correlated with COVID-19 pneumonia. Hemoptysis, low lymphocytes, high procalcitonin or ferritin were concerned with kidney allograft prognosis post-COVID-19.