To analyse the difference in COVID-19 infection between kidney transplant patients and non-transplant patients. We included post-transplant patients with COVID-19 infection who attended Shenzhen No. 3 Hospital from December 2022 to February 2023, and enrolled the general population with COVID-19 infection who were hospitalized during the same period, matched by age and gender. They were divided into Kidney Transplant Recipients group (KTR) (n=194) and Non-Kidney Transplant Recipients Group（NKTR）(n=516) and the basic information, clinical symptoms, laboratory data, treatments and outcomes of these two groups were compared. The proportion of the renal transplant population classified as severe and critical was 15.5%, which was significantly higher than that in NKTR group (P < 0.05); the proportion of patients with pneumonia was also significantly higher than that in NKTR group. The mean maximum fever temperature was slightly higher in the NKTR( P<0.001);Kidney transplant population having lower absolute lymphocyte counts on admission and 7 days after admission than the general population, with statistically significant differences（ P<0.001, P＜0.001). The use of intravenous hormones was significantly higher (42.8% vs. 6.0%, p=0.000), as was the use of small molecules such as Azvudine and Paxlovid, compared to the general population. A total of 10 patients in the included population required ICU admission, all in the KTR group; six patients experienced death, also in the renal transplant group. Conclusion: Post-transplant COVID-19 infections are more severe and require hormonal and small molecule antiviral therapy, and the prognosis is worse than in the general population.

Background We analyzed the effects of small-molecule antiviral treatment for coronavirus disease-2019 (COVID-19) Omicron strain in kidney transplant recipients. Methods We enrolled 140 kidney transplant patients admitted for COVID-19-related pneumonia were treated using small-molecule antivirals. Patients were divided into three groups: azvudine (n=62), paxlovid (n=49), and a combination of azvudine+paxlovid (A+P, n=29). Differences in clinical outcomes owing to COVID-19 infections were compared among three groups. Results Paxlovid group had a higher proportion of comorbid diabetes than the other two groups (P=0.032). There were differences in the clinical typing of the coronavirus , with the highest proportion of heavy and critical cases in the A+P group (35.5%). The immunosuppression prior to infection did not differ among the groups; however, after adjusting for immunosuppression during antiviral treatment, differences were observed. Of the 140 patients, 125 (89.29%) had fever, 114 (81.43%) had cough, and 66 (47.1%) had malaise. Combination of two or more symptoms were found in 90% patients. Mean length of hospitalization was slightly longer in the combination group than in the azvudine and paxlovid groups. Four deaths, all in the A+P group; five cases of loss of function, two in the paxlovid group and three in the A+P group; and acute kidney injury occurred in 30 patients with 7 in the azvudine, 17 in paxlovid, and 6 in A+P groups. Conclusion The use of small-molecule medications may be the optimal treatment approach; however, they should be modified based on the patients’ conditions, such as clinical symptoms, laboratory results, paraclinicals, and examinations.