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

2020; Oxford University Press; Volume: 73; Issue: 11 Linguagem: Inglês

10.1093/cid/ciaa1097

1537-6591

Olivia S. Kates, Brandy Haydel, Sander Florman, Meenakshi Rana, Zohra Chaudhry, Mayur Ramesh, Kassem Safa, Camille N. Kotton, Emily A. Blumberg, Behdad Besharatian, Sajal D. Tanna, Michael G. Ison, Maricar Malinis, Marwan M. Azar, Robert M. Rakita, Jose A Morilla, Aneela Majeed, Afrah S. Sait, Mario Spaggiari, Vagish Hemmige, Sameer Mehta, Henry Neumann, Abbasali Badami, Jason D. Goldman, Anuradha Lala, Marion Hemmersbach‐Miller, Margaret McCort, Valida Bajrovic, Carlos Ortiz‐Bautista, Rachel Friedman‐Moraco, Sameep Sehgal, Erika D. Lease, Cynthia E. Fisher, Ajit P. Limaye, Akanksha Arya, Amy Jeng, Alexander Kuo, Alfred Luk, Alfredo Puing, Ana Rossi, A. Brueckner, Ashrit Multani, Brian C. Keller, Darby Derringer, Diana F. Florescu, Edward A. Dominguez, Elena Sandoval, Erin P Bilgili, Faris Hashim, Fernanda P. Silveira, Ghady Haidar, Hala Joharji, Haris Murad, Imran Gani, J.M. El-Amm, Joseph Kahwaji, Joyce Popoola, Julie M. Yabu, Kailey Hughes, Kapil Saharia, Kiran Gajurel, Lyndsey J. Bowman, Massimiliano Veroux, Megan Morales, Monica Fung, Nicole Theodoropoulos, Oveimar De La Cruz, Rajan Kapoor, Ricardo M. La Hoz, Sridhar R. Allam, Surabhi B Vora, Todd P McCarty, Tracy Anderson-Haag, Uma Malhotra, Ursula M Kelly, Vidya Bhandaram, William M. Bennett, Zurabi Lominadze,

Renal Transplantation Outcomes and Treatments

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.