When Maria, a 42-year-old schoolteacher from Maryland, caught COVID-19 two years after her kidney transplant, she faced a difficult question: would the infection cost her the new kidney she had waited years to receive? Today, new research from Johns Hopkins Medicine suggests that a common antiviral treatment may have given her — and thousands like her — a much better chance of keeping that precious organ.
A study published in the journal JAMA Network Open followed 432 adult kidney transplant recipients who contracted COVID-19 between March 2020 and January 2024. Researchers at Johns Hopkins tracked what happened to these patients over the following year, comparing those who received remdesivir — an antiviral drug given through an IV — within a week of their diagnosis against those who did not.
The results were striking. Patients who got early remdesivir treatment, for at least three consecutive days, were 47% less likely to experience graft loss — meaning their transplanted kidney failed or they died from any cause. They also had a 42% lower risk of cardiovascular complications like heart attack or stroke.
"These findings suggest that timely antiviral treatment may have benefits beyond the acute phase of COVID-19 in this population," said Dr. Nitipong Permpalung, the study's senior author and associate director of the Johns Hopkins Transplant Research Center. He hopes the findings will help ease concerns doctors may have about prescribing remdesivir to kidney transplant recipients.
Among all 432 patients in the study, 11% experienced graft loss, 10% had cardiovascular problems, and 8% died from any cause. Many participants faced additional challenges: 95% had high blood pressure, 46% had diabetes, and one in five needed supplemental oxygen when diagnosed. About a quarter had received their transplant less than a year before catching COVID-19.
Kidney transplant recipients are often excluded from standard clinical trials because their bodies respond differently to treatments and they face higher risks of complications. This makes studies like this one especially valuable — it is one of the largest to track their long-term outcomes after COVID-19.
The researchers caution that trends toward reduced death rates were seen but were not statistically significant, meaning they could have occurred by chance. The analysis for long COVID was also inconclusive due to limited documented cases.
Still, for a community that has long faced elevated risks, the findings offer a practical takeaway: acting quickly with existing antiviral treatments may protect more than just the lungs — it may protect the kidney itself.