*Purpose: The COVID outbreak occurred 2 yrs after conduct of a prospective randomized trial in kidney transplants (KT) receiving Belatacept (B) or Tacrolimus (T). The impact of COVID in KT from two highest enrolling centers is reported.
*Methods: Exclusion criteria were death or graft loss prior Jan 2020, loss to follow up before Jan 2020, and COVID data unavailable in EMR. Intent to treat analysis was performed on 133 KT (B, n=86, T, n=47). Logistic regression assessed univariate associations between factors and COVID hospitalization. Nonparsimonious model was developed including all factors significant at the 0.10 level.
*Results: Groups were matched demographically. Vaccination rates ≥ 2 doses were similar among B and T groups (B: n=64, 74%; T: n=41, 87%). COVID+ cases were similar (B: n=36, 42%; T: n=19, 40%). Patient characteristics are summarized in Table 1. No differences observed between treatment of COVID+ pts. COVID hospitalization was similar (B: n=14, 16%; T: n=5, 11%). COVID deaths were similar (B: n=5, 6%; T: n=2, 4%). 2 deaths occurred in 2021 and 5 occurred in 2022. COVID hospitalized pts had lower vaccination rates prior to COVID positive test (both groups: 19/55 hospitalized; 12/19 unvaccinated or not reported). (Table 2). Univariate predictors of COVID hospitalization are age, AA race, pre-txp DM, and less than 2 vaccine doses, while AA race and less than 2 vaccine doses were predictive in the multivariate model (Table 3 and Figure 1).
*Conclusions: Among B and T treated KT, vaccination rates, COVID+ case rates, COVID hospitalizations, and COVID-related death were similar. Predictors of COVID hospitalization are AA race and less than 2 doses of COVID vaccine. Importantly, assignment to either B or T did not appear to influence risk of hospitalization.

Mina Chau

University of Cincinnati

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