SARS-CoV-2 infection and early mortality of waitlisted and solid organ transplant recipients in England: A national cohort study

Abstract

Patients waitlisted for and recipients of solid organ transplants (SOT) are perceived to have a higher risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and death; however, definitive epidemiological evidence is lacking. In a comprehensive national cohort study enabled by linkage of the UK transplant registry and Public Health England and NHS Digital Tracing services, we examined the incidence of laboratory-confirmed SARS-CoV-2 infection and subsequent mortality in patients on the active waiting list for a deceased donor SOT and recipients with a functioning SOT as of February 1, 2020 with follow-up to May 20, 2020. Univariate and multivariable techniques were used to compare differences between groups and to control for case-mix. One hundred ninety-seven (3.8%) of the 5184 waitlisted patients and 597 (1.3%) of the 46 789 SOT recipients tested positive for SARS-CoV-2. Mortality after testing positive for SARS-CoV-2 was 10.2% (20/197) for waitlisted patients and 25.8% (154/597) for SOT recipients. Increasing recipient age was the only variable independently associated with death after positive SARS-CoV-2 test. Of the 1004 transplants performed in 2020, 41 (4.1%) recipients have tested positive for SARS-CoV-2 with 8 (0.8%) deaths reported by May 20. These data provide evidence to support decisions on the risks and benefits of SOT during the coronavirus disease 2019 pandemic.

FIGURE 1

Flowchart of study cohorts [Colour figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Cumulative number of solid organ transplant recipients and waitlisted patients with positive severe acute respiratory syndrome coronavirus-type 2 swabs and subsequent all-cause mortality in England, February 1 to May 20, 2020, compared to the general English population [Colour figure can be viewed at wileyonlinelibrary.com]

FIGURE 3

Patient survival from the date of SARS-CoV-2-positive swab in wait-list patients and solid organ transplant recipients. CI, confidence interval; SARS-CoV-2, severe acute respiratory syndrome coronavirus-type 2 [Colour figure can be viewed at wileyonlinelibrary.com]

FIGURE 4

Risk of becoming SARS-CoV-2, severe acute respiratory syndrome coronavirus-type 2–positive and subsequent death for waiting-list and solid organ transplant recipients by organ type, February 1 to 20, May 2020. SPK, simultaneous pancreas-kidney [Colour figure can be viewed at wileyonlinelibrary.com]