Abstract: SA-PO1127
Paxlovid Therapy for Kidney Transplant Recipients with COVID-19 Infection in the Outpatient Setting
Session Information
- Transplantation: Clinical - Infectious Diseases
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- St John, Briana, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
- Leonard, Emily E., The University of New Mexico Hospital, Albuquerque, New Mexico, United States
- Dauenhauer, Ashlee, The University of New Mexico Hospital, Albuquerque, New Mexico, United States
- Garcia, Pablo, The University of New Mexico Hospital, Albuquerque, New Mexico, United States
- Singh, Pooja P., The University of New Mexico Hospital, Albuquerque, New Mexico, United States
Background
Paxlovid (Nirmatrelvir/Ritonavir) has been shown to be an effective therapy for COVID-19 infection in the outpatient setting. Here we describe kidney outcomes among kidney transplant recipients (KTR) in New Mexico (NM) who were treated with Paxlovid for a COVID-19 diagnosis.
Methods
This is a single center retrospective chart review of KTRs in NM who were treated with Paxlovid for COVID-19 infection between June 2022 through October 2024 in the outpatient setting. Data was collected for one year following treatment. The primary objective reviewed adverse renal effects related to Paxlovid administration including acute kidney injury (AKI), and the secondary objective reviewed outcomes related to decreasing immunosuppression (IS) while on Paxlovid. Only patients receiving calcineurin inhibitors (CNI) for one of their maintenance IS medications were included in the study.
Results
We included 81 KTRs in this cohort, 38.8% Hispanic White, 35.5% non-Hispanic White, 22% American Indian, 2.5% Black , and 1.2% Asian. Median age at time of diagnosis was 52 with 39.5% male and 60.5% female. The most common symptom at time of COVID-19 diagnosis was congestion, 50.6% and cough, 48.1%. 97.5% had CNI held while on Paxlovid and 78.2% had their antimetabolite dose reduced. CNI was resumed after completion of Paxlovid therapy but held further if levels were supratherapeutic. 20.9% had a supratherapeutic CNI level of 15 ng/mL or higher one week after stopping Paxlovid. Only two patients experienced AKI due to supratherapeutic CNI levels which resolved two weeks after stopping Paxlovid. 3.7% of patients developed ABMR within 6 months of COVID-19 diagnosis and one of these patients progressed to graft failure within 1 year. 4.9% developed AKI 3 months post COVID-19 diagnosis that did not resolve, though none had rejection and all continued to have a functioning graft at one year post COVID-19 diagnosis.
Conclusion
Paxlovid should be considered for therapy in immunocompromised KTRs who develop COVID-19 infection in the outpatient setting. It is a safe therapy that may lead to less hospitalizations in KTRS and was not associated with poor kidney outcomes in our study.