I always wondered about this. It makes sense since a kidney transplant restores almost all the functions of the original kidneys. Likely why Medicare cancels ESRD coverage three years after transplant.
I saw this paper recently: Electronic health record analysis identifies kidney disease as the leading risk factor for hospitalization in confirmed COVID-19 patients
Even though kidney transplant recipients are no longer classified as ESRD patients, this study shows that they are still as susceptible to hospitalization as those with Stage 5 ESRD. Table 4 in the paper shows:
Additional analyses using eGFR and USRDS data confirmed our findings that patients with stage 4–5 CKD, ESRD on dialysis or with kidney transplant are at extremely high risk for severe complications due to COVID-19 (Table 4).
It appears that patients with eGFR < 15 are 13x more likely to be hospitalized with COVID-19 as compared to those without ESRD. The paper suggests that “physiological stress caused by excessive inflammatory response to SARS-COV-2 infection could destabilize organs already weakened by chronic disease” or “direct organ-specific injury from SARS-CoV-2 infection could act as a second-hit to these organs.” The article also mentions “consistent with this hypothesis, kidney and heart are among the tissues with the highest expression of ACE2, a SARS-CoV-2 receptor.”
So why is the results so high for kidney transplant patients? The n value is low at only seven cases, but the risk is about the same as Stage 5 ESRD or dialysis patients. The article does not discuss this finding, but my guess is the immunosuppressive medications weaking the patient’s immune system. That and a muted antibody response to COVID vaccines. This means even though I have a kidney transplant, the risks of COVID have not changed for me versus one-year ago while I was still on dialysis.
Life with chronic diseases 