Clinical characteristics and outcomes of COVID‐19 in solid organ transplant recipients: A cohort study

• Published in: American journal of transplantation Vol. 20; no. 11; pp. 3051 - 3060
• Main Authors: Chaudhry, Zohra S., Williams, Jonathan D., Vahia, Amit, Fadel, Raef, Parraga Acosta, Tommy, Prashar, Rohini, Shrivastava, Pritika, Khoury, Nadeen, Pinto Corrales, Julio, Williams, Celeste, Nagai, Shunji, Abouljoud, Marwan, Samaniego‐Picota, Milagros, Abreu‐Lanfranco, Odaliz, Busto, Ramon, Ramesh, Mayur S., Patel, Anita, Alangaden, George J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.11.2020; John Wiley and Sons Inc
• Subjects: Aged; clinical research/practice; Cohort analysis; Comorbidity; complication: infectious; Coronaviruses; COVID-19; COVID-19 - epidemiology; Diabetes mellitus; Diarrhea; Female; Graft Rejection - epidemiology; Graft Rejection - prevention & control; Humans; Immunosuppression; Immunosuppression Therapy - methods; Incidence; infection and infectious agents ‐ viral; infectious disease; Intensive Care Units; Kidney diseases; kidney transplantation/nephrology; Kidney transplants; Kidneys; Male; Mechanical ventilation; Middle Aged; Mortality; Multivariate analysis; Organ Transplantation; organ transplantation in general; Original; ORIGINAL ARTICLES; Pandemics; Retrospective Studies; Risk Factors; SARS-CoV-2; Transplant Recipients; United States - epidemiology; United States; infectious disease; organ transplantation in general; infection and infectious agents - viral; clinical research/practice; kidney transplantation/nephrology; complication: infectious
• ISSN: 1600-6135; 1600-6143; 1600-6143
• DOI: 10.1111/ajt.16188

Solid organ transplant recipients (SOTr) with coronavirus disease 2019 (COVID‐19) are expected to have poorer outcomes compared to nontransplant patients because of immunosuppression and comorbidities. The clinical characteristics of 47 SOTr (38 kidneys and 9 nonkidney organs) were compared to 100 consecutive hospitalized nontransplant controls. Twelve of 47 SOTr managed as outpatients were subsequently excluded from the outcome analyses to avoid potential selection bias. Chronic kidney disease (89% vs 57% P = .0007), diabetes (66% vs 33% P = .0007), and hypertension (94% vs 72% P = .006) were more common in the 35 hospitalized SOTr compared to controls. Diarrhea (54% vs 17%, P < .0001) was more frequent in SOTr. Primary composite outcome (escalation to intensive care unit, mechanical ventilation, or in‐hospital all‐cause mortality) was comparable between SOTr and controls (40% vs 48%, odds ratio [OR] 0.72 confidence interval [CI] [0.33‐1.58] P = .42), despite more comorbidities in SOTr. Acute kidney injury requiring renal replacement therapy occurred in 20% of SOTr compared to 4% of controls (OR 6 CI [1.64‐22] P = .007). Multivariate analysis demonstrated that increasing age and clinical severity were associated with mortality. Transplant status itself was not associated with mortality. Solid organ transplant recipients have similar mortality compared to nontransplant patients during hospitalization for COVID‐19.