Remdesivir may protect kidney transplants after COVID-19

Clinical takeaway: For kidney transplant recipients with COVID-19 who are eligible for antiviral therapy, these findings support timely remdesivir treatment, which was associated with lower risks of graft loss and cardiovascular complications through one year of follow-up.

Kidney transplant recipients remain at high risk for severe COVID-19 and its long-term complications, yet they have largely been excluded from pivotal randomized antiviral trials. A new study suggests that the benefits of early remdesivir may extend well beyond the acute infection.

Researchers analyzed 432 adult kidney transplant recipients with symptomatic COVID-19 treated at five Johns Hopkins hospitals between March 2020 and January 2024. Patients who received at least three consecutive days of intravenous remdesivir within seven days of diagnosis were compared with similar patients who did not receive remdesivir. Those treated with other COVID-19 antivirals or monoclonal antibodies were excluded.

Over one year of follow-up, early remdesivir was associated with a 47% lower risk of graft loss—a composite of graft failure or death—and a 42% lower risk of cardiovascular complications, including myocardial infarction, stroke, or cardiac death. No significant reduction in all-cause mortality was observed, and there were too few cases of long COVID to determine whether remdesivir affected that outcome.

Because kidney transplant recipients have been underrepresented in COVID-19 antiviral trials, clinicians have had limited evidence to guide treatment decisions. This study helps fill that gap by providing one-year outcome data in a population at particularly high risk for graft failure and cardiovascular complications.

Source: Srisurapanont K, et al. (2026 July 28) JAMA Netw Open. Early remdesivir treatment and long-term outcomes in adult kidney transplant recipients with COVID-19