Abstract
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.Free full text
COVID-19 in solid organ transplant: A multi-center cohort study
Abstract
Background
The 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 multi-center 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 (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 [aOR 3.0, 95%CI 1.7-5.5, p<0.001], congestive heart failure [aOR 3.2, 95%CI 1.4-7.0, p=0.004], chronic lung disease [aOR 2.5, 95%CI 1.2-5.2, p=0.018], obesity [aOR 1.9, 95% CI 1.0-3.4, p=0.039]) and presenting findings (lymphopenia [aOR 1.9, 95%CI 1.1-3.5, p=0.033], abnormal chest imaging [aOR 2.9, 95%CI 1.1-7.5, p=0.027]) 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.
Full text links
Read article at publisher's site: https://doi.org/10.1093/cid/ciaa1097
Read article for free, from open access legal sources, via Unpaywall: https://academic.oup.com/cid/article-pdf/73/11/e4090/41607755/ciaa1097.pdf
Citations & impact
Impact metrics
Article citations
Risk factors for SARS-CoV-2 infection and severe COVID-19 in unvaccinated solid organ transplant recipients.
Sci Rep, 14(1):26465, 02 Nov 2024
Cited by: 0 articles | PMID: 39488631 | PMCID: PMC11531510
T-Cell Immune Responses to SARS-CoV-2 Infection and Vaccination.
Vaccines (Basel), 12(10):1126, 30 Sep 2024
Cited by: 0 articles | PMID: 39460293 | PMCID: PMC11511197
Review Free full text in Europe PMC
Bringing optimised COVID-19 vaccine schedules to immunocompromised populations (BOOST-IC): study protocol for an adaptive randomised controlled clinical trial.
Trials, 25(1):485, 17 Jul 2024
Cited by: 0 articles | PMID: 39020446 | PMCID: PMC11253462
Risk Factors for Impaired Cellular or Humoral Immunity after Three Doses of SARS-CoV-2 Vaccine in Healthy and Immunocompromised Individuals.
Vaccines (Basel), 12(7):752, 08 Jul 2024
Cited by: 0 articles | PMID: 39066390 | PMCID: PMC11281526
Long-term follow-up of kidney transplant recipients admitted to a tertiary care transplant center with SARS-CoV-2.
World J Virol, 13(2):95273, 01 Jun 2024
Cited by: 0 articles | PMID: 38984080
Go to all (249) article citations
Similar Articles
To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation.
Excess mortality in solid organ transplant recipients hospitalized with COVID-19: A large-scale comparison of SOT recipients hospitalized with or without COVID-19.
Clin Transplant, 36(1):e14492, 01 Oct 2021
Cited by: 31 articles | PMID: 34558116 | PMCID: PMC8646895
Outcomes of COVID-19 in Solid Organ Transplant Recipients: A Propensity-matched Analysis of a Large Research Network.
Transplantation, 105(6):1365-1371, 01 Jun 2021
Cited by: 72 articles | PMID: 33988341 | PMCID: PMC8414593
Coronavirus Disease 2019 (COVID-19) in Solid Organ Transplant Recipients: A Case-Control Study.
Ann Transplant, 26:e933152, 12 Nov 2021
Cited by: 4 articles | PMID: 34764235 | PMCID: PMC8594113
COVID-19 and solid organ transplantation: Finding the right balance.
Transplant Rev (Orlando), 36(3):100710, 04 Jul 2022
Cited by: 9 articles | PMID: 35809422 | PMCID: PMC9251959
Review Free full text in Europe PMC
Funding
Funders who supported this work.
NCATS NIH HHS (1)
Grant ID: UL1 TR001863
NHLBI NIH HHS (1)
Grant ID: K23 HL143050
NIAID NIH HHS (2)
Grant ID: T32 AI100851
Grant ID: T32 AI118690