Coronavirus disease 2019 in solid organ transplant: a multicenter cohort study

OS Kates, BM Haydel, SS Florman… - Clinical Infectious …, 2021 - academic.oup.com
OS Kates, BM Haydel, SS Florman, MM Rana, ZS Chaudhry, MS Ramesh, K Safa
Clinical Infectious Diseases, 2021academic.oup.com
Background The coronavirus disease 2019 (COVID-19) pandemic has led to significant
reductions in transplantation, motivated in part by concerns of disproportionately more
severe disease among solid organ transplant (SOT) recipients. However, clinical features,
outcomes, and predictors of mortality in SOT recipients are not well described. Methods We
performed a multicenter cohort study of SOT recipients with laboratory-confirmed COVID-19.
Data were collected using standardized intake and 28-day follow-up electronic case report …
Background
The coronavirus disease 2019 (COVID-19) pandemic has led to significant reductions in transplantation, motivated in part by concerns of disproportionately more severe disease among solid organ transplant (SOT) recipients. However, clinical features, outcomes, and predictors of mortality in SOT recipients are not well described.
Methods
We performed a multicenter cohort study of SOT recipients with laboratory-confirmed COVID-19. Data were collected using standardized intake and 28-day follow-up electronic case report forms. Multivariable logistic regression was used to identify risk factors for the primary endpoint, 28-day mortality, among hospitalized patients.
Results
Four hundred eighty-two SOT recipients from >50 transplant centers were included: 318 (66%) kidney or kidney/pancreas, 73 (15.1%) liver, 57 (11.8%) heart, and 30 (6.2%) lung. Median age was 58 (interquartile range [IQR] 46–57), median time post-transplant was 5 years (IQR 2–10), 61% were male, and 92% had ≥1 underlying comorbidity. Among those hospitalized (376 [78%]), 117 (31%) required mechanical ventilation, and 77 (20.5%) died by 28 days after diagnosis. Specific underlying comorbidities (age >65 [adjusted odds ratio [aOR] 3.0, 95% confidence interval [CI] 1.7–5.5, P < .001], congestive heart failure [aOR 3.2, 95% CI 1.4–7.0, P = .004], chronic lung disease [aOR 2.5, 95% CI 1.2–5.2, P = .018], obesity [aOR 1.9, 95% CI 1.0–3.4, P = .039]) and presenting findings (lymphopenia [aOR 1.9, 95% CI 1.1–3.5, P = .033], abnormal chest imaging [aOR 2.9, 95% CI 1.1–7.5, P = .027]) were independently associated with mortality. Multiple measures of immunosuppression intensity were not associated with mortality.
Conclusions
Mortality among SOT recipients hospitalized for COVID-19 was 20.5%. Age and underlying comorbidities rather than immunosuppression intensity-related measures were major drivers of mortality.
Oxford University Press