Coronavirus Disease 2019 in Solid Organ Transplant: A Multicenter Cohort Study

• Type of Material: Article
• Authors: Olivia S. Kates, University of Washington; Brandy M. Haydel, Icahn School of Medicine at Mount Sinai; Sander S. Florman, Icahn School of Medicine at Mount Sinai; Meenakshi M. Rana, Icahn School of Medicine at Mount Sinai; Zohra S. Chaudhry, Henry Ford Health System; Mayer S. Ramesh, Henry Ford Health System; Kassem Safa, Massachusetts General Hospital; Camille Nelson Kotton, Massachusetts General Hospital; Emily A. Blumberg, Penn Medicine; Behdad D. Besharatian, Penn Medicine; Sajal D. Tanna, Northwestern University Feinberg School of Medicine; Michael G. Ison, Northwestern University Feinberg School of Medicine; Marcicar Malinis, Yale University; Marwan Azar, Yale University; Robert M. Rakita, University of Washington; Jose A. Morilla, Cleveland Clinic Foundation; Aneela Majeed, Cleveland Clinic Foundation; Afrah S. Sait, Johns Hopkins University; Mario Spaggiari, University of Illinois at Chicago; Vagish Hemmige, Montefiore Medical Center; Sapna A. Mehta, NYU Langone Health; Henry Neumann, NYU Langone Health; Abbsali Badami, SUNY Downstate Health Sciences University; Jason D. Goldman, University of Washington; Anuradha Lala, Icahn School of Medicine at Mount Sinai; Marion Hemmersbach-Miller, Baylor College of Medicine; Margaret McCort, Montefiore Medical Center; Valida Bajrovic, University of Colorado Anschutz Medical Campus; Carlos Ortiz-Bautista, Hospital General Universitario Gregorio Marañon; Rachel Friedman-Moraco, Emory University; Sameep Sehgal, Temple University; Erika D. Lease, University of Washington; Cynthia E. Fisher, University of Washington; Ajit P. Limaye, University of Washington
• Language: English
• Date: 2021-01-01
• Publisher: Oxford University Press
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1093/cid/ciaa1097
• Title of Journal or Parent Work: Clinical Infectious Diseases
• Volume: 73
• Issue: 11
• Start Page: E4090
• End Page: E4099
• Grant/Funding Information: None declared
• Keywords: Transplant Recipients; transplantation; COVID-19; Organ Transplantation; Male; coronavirus; SARS-CoV-2; Cohort Studies; solid organ transplantation; Middle Aged; Humans
• Research Categories: Health Sciences, Immunology; Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management; Health Sciences, Epidemiology

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.