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Competing Interests: A. Agarwal reports consultancy for Akebia Therapeutics and Dynamed; serving on the medical advisory board of Creegh Pharmaceuticals; ownership interest in Creegh Pharmaceuticals and Goldilocks Therapeutics, Inc.; research funding from Genzyme/Sanofi Fabry Fellowship Award; honoraria from the University of Maryland, University of Toledo, and University of Virginia; having a pending patent that describes small molecule inducers of heme oxygenase-1 for the treatment of acute and chronic kidney disease; being on the editorial board of the American Journal of Physiology-Renal Physiology, Kidney International, and Laboratory Investigation; being invited to serve on the advisory board of Goldilocks Therapeutics; serving on the advisory boards of Alpha Young, LLC, Angion, Creegh Pharmaceuticals, and Zydus; and being the spouse of the President for Women in Nephrology (2020–2022). J. Cerda reports ownership interest in New York Nephrology (shareholder); an advisory or leadership role with the American Society of Nephrology (chair of the AKINow Initiative), International Society Nephrology (AKI Committee and co-chair of the 0by25 Initiative), International Society of Nephrology (chair of the Advocacy Working Group); and other interests or relationships with the ASN AKINow Initiative (associate director of the 0by25 Initiative), the ASN Online AKI Community (member), and the International Society of Nephrology. M.D. Okusa reports employment by the University of Virginia Health System; consultancy for HemoShear and Janssen; ownership interest in AAPL; Allstate (ALL), Citigroup (C), Nextera Energy (NEE), Pepsico (PEP), Walmart (WAL); BABA, AIG, BK, BCS, BP, CAH, CRRFY, CI, C, CMCSA, CRH, CVS, ERJ, EMR, ENIC, ENGIY, E, EBKDY, FNMA, FDX, FISV, FLEX, FMX, F, FCX, GE, GD, GEBHY, GSK, GRFS, HAL, HCA, HDELY, HMC, INGR, JSAIY, JPM, KGFHY, LH, MCK, MRK, MU, MHK, OMF, OGN, PFE, PNC, PUBGY, REPYY, RDS B, SNY, SBGSY, STT, SMFG, VIV, TSCDY, TXT, TTE; research funding from AM Pharma/Pfizer and the National Institutes of Health (research grant); honoraria from the Cleveland Clinic Foundation, the Korean Society of Nephrology, the University of Tokyo, and UptoDate; patents or royalties from the University of Virginia Patent Office; an advisory or leadership role for NIDDH/NIDDK Data and Safety Monitoring Board; and other interests or relationships with the John Bower Foundation (travel). S.M. Parikh reports consultancy for Aerpio, Alkermes, Astellas, Boehringer Ingelheim, Cytokinetics, Entrada Therapeutics, Flagship Pioneering, Janssen, Leerink Swann, Merck, Mission Therapeutics, Mitobridge, NovMeta, and Pfizer; research funding from Baxter; patents or royalties from UpToDate; an advisory or leadership role with the Journal of the American Society of Nephrology and Kidney360; and other interests or relationships with the American Association of Physicians, American Society for Clinical Investigation, the American Society of Nephrology, and the International Society of Nephrology. All remaining authors have nothing to disclose.

Competing Interests: All authors have nothing to disclose.

Background: De novo post-transplant diabetes mellitus (PTDM) is a common complication after kidney transplant (KT). Most recent studies are single center with various approaches to outcome ascertainment., Methods: In a multicenter longitudinal cohort of 632 nondiabetic adult kidney recipients transplanted in 2010-2013, we ascertained outcomes through detailed chart review at 13 centers. We hypothesized that donor characteristics, such as sex, HCV infection, and kidney donor profile index (KDPI), and recipient characteristics, such as age, race, BMI, and increased HLA mismatches, would affect the development of PTDM among KT recipients. We defined PTDM as hemoglobin A1c ≥6.5%, pharmacological treatment for diabetes, or documentation of diabetes in electronic medical records. We assessed PTDM risk factors and evaluated for an independent time-updated association between PTDM and graft failure using regression., Results: Mean recipient age was 52±14 years, 59% were male, 49% were Black. Cumulative PTDM incidence 5 years post-KT was 29% (186). Independent baseline PTDM risk factors included older recipient age ( P <0.001) and higher BMI ( P =0.006). PTDM was not associated with all-cause graft failure (adjusted hazard ratio (aHR), 1.10; 95% CI, 0.78 to 1.55), death-censored graft failure (aHR, 0.85; 95% CI, 0.53 to 1.37), or death (aHR, 1.31; 95% CI, 0.84 to 2.05) at median follow-up of 6 (interquartile range, 4.0-6.9) years post-KT. Induction and maintenance immunosuppression were not different between patients who did and did not develop PTDM., Conclusions: PTDM occurred commonly, and higher baseline BMI was associated with PTDM. PTDM was not associated with graft failure or mortality during the 6-year follow-up, perhaps due to the short follow-up time., Competing Interests: C.R. Parikh reports receiving a consulting fee from and Genfit (Data Safety Monitoring Board) and Renalytix (Advisory Board), and reports receiving grant/research support from National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Heart, Lung and Blood Institute (NHLBI). E. Akalin reports receiving a research grant from CareDx and National Institutes of Health (NIH). F.L. Weng reports receiving NIH grant support from the National Institute on Minority Health and Health Disparities (NIMHD) (R01MD00766405). J.S. Bromberg reports receiving grant support from NIH (NIDDK/National Institute of Allergy and Infectious Diseases [NIAID]/NIMHD/NHLBI). M.D. Doshi reports receiving salary support from NIDDK. M.N. Harhay reports receiving NIH grant support from NIDDK (K23DK105207 and R01DK124388) and National Science Foundation (NSF) grant support (award 2035007). P.P. Reese reports epidemiology consulting for VALHeath related to identifying patients with CKD; reports receiving investigator-initiated and collaborative grants from AbbVie and Merck to the University of Pennsylvania to support trials of transplanting organs from donors with hepatitis C into hepatitis C–negative recipients; reports receiving investigator-initiated grants from CVS to the University of Pennsylvania to support studies of medication adherence; and reports being an Associate Editor for American Journal of Kidney Disease. S.G. Mansour reports being supported by the American Heart Association (18CDA34110151) and Patterson Trust Fund. S. Mohan reports receiving grant and research support from the NIH (NIDDK/NIAID/NIHMD/NIBIB) and NSF; reports receiving consulting fees from Angion BIomedica; and reports being Deputy Editor, Kidney International Reports. All remaining authors have nothing to disclose., (Copyright © 2021 by the American Society of Nephrology.)

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can infect any human host, but kidney transplant recipients (KTR) are considered more susceptible on the basis of previous experience with other viral infections. We evaluated rates of hospital complications between SARS-CoV-2-positive KTR and comparator groups., Methods: We extracted data from the electronic health record on patients who were hospitalized with SARS-CoV-2, testing at six hospitals from March 4 through September 9, 2020. We compared outcomes between SARS-CoV-2-positive KTR and controls: SARS-CoV-2-positive non-KTR, SARS-CoV-2-negative KTR, and SARS-CoV-2-negative non-KTR., Results: Of 31,540 inpatients, 3213 tested positive for SARS-CoV-2. There were 32 SARS-CoV-2-positive and 224 SARS-CoV-2-negative KTR. SARS-CoV-2-positive KTR had higher ferritin levels (1412; interquartile range, 748-1749 versus 553; interquartile range, 256-1035; P <0.01) compared with SARS-CoV-2-positive non-KTR. SARS-CoV-2-positive KTR had higher rates of ventilation (34% versus 14%, P <0.01; versus 9%, P <0.01; versus 5%, P <0.01), vasopressor use (41% versus 16%, P <0.01; versus 17%, P <0.01; versus 12%, P <0.01), and AKI (47% versus 15%, P <0.01; versus 23%, P <0.01; versus 10%, P <0.01) compared with SARS-CoV-2-positive non-KTR, SARS-CoV-2-negative KTR, and SARS-CoV-2-negative non-KTR, respectively. SARS-CoV-2-positive KTR continued to have increased odds of ventilation, vasopressor use, and AKI compared with SARS-CoV-2-positive non-KTR independent of Elixhauser score, Black race, and baseline eGFR. Mortality was not significantly different between SARS-CoV-2-positive KTR and non-KTR, but there was a notable trend toward higher mortality in SARS-CoV-2-positive KTR (25% versus 16%, P =0.15, respectively)., Conclusions: Hospitalized SARS-CoV-2-positive KTR had a high rate of mortality and hospital complications, such as requiring ventilation, vasopressor use, and AKI. Additionally, they had higher odds of hospital complications compared with SARS-CoV-2-positive non-KTR after adjusting for Elixhauser score, Black race, and baseline eGFR. Future studies with larger sample size of KTR are needed to validate our findings., Podcast: This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2021&#95;03&#95;25&#95;KID0005652020.mp3., Competing Interests: E. Marin reports having consultancy agreements with Natera and Veloxis; reports being a scientific advisor or member of the Kidney360 Review Board; and reports having other interests/relationships as a member of the American Society of Nephrology and American Society of Transplantation. D. Moledina reports a patent to Systems and Methods to Diagnose Acute Interstitial Nephritis pending. F. Wilson reports having consultancy agreements with Translational Catalyst, LLC; reports having an ownership interest in Efference, LLC; reports being a scientific advisor or member of the Editorial Board of the American Journal of Kidney Disease and the Editorial Board of CJASN; and reports other interests/relationships as Board of Directors of Gaylord Health Care and Medical Commentator of Medscape. All remaining authors have nothing to disclose., (Copyright © 2021 by the American Society of Nephrology.)