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. 2021 May;21(5):1825-1837.
doi: 10.1111/ajt.16369. Epub 2020 Nov 10.

COVID-19 in transplant recipients: The Spanish experience

Elisabeth Coll  1 , Mario Fernández-Ruiz  2   3 , J Emilio Sánchez-Álvarez  4   5 , José R Martínez-Fernández  1 , Marta Crespo  6   7   8 , Jorge Gayoso  1 , Teresa Bada-Bosch  9 , Federico Oppenheimer  10 , Francesc Moreso  11 , María O López-Oliva  12 , Edoardo Melilli  13 , Marisa L Rodríguez-Ferrero  14 , Carlos Bravo  15 , Elena Burgos  16 , Carme Facundo  17 , Inmaculada Lorenzo  18 , Íñigo Yañez  19 , Cristina Galeano  20 , Ana Roca  21 , Mercedes Cabello  22 , Manuel Gómez-Bueno  23 , MªDolores García-Cosío  24   25 , Javier Graus  26 , Laura Lladó  27 , Alicia de Pablo  28 , Carmelo Loinaz  29 , Beatriz Aguado  30 , Domingo Hernández  31   32   33 , Beatriz Domínguez-Gil  1 ; Spanish Group for the Study of COVID-19 in Transplant Recipients
Affiliations

COVID-19 in transplant recipients: The Spanish experience

Elisabeth Coll et al. Am J Transplant. 2021 May.

Abstract

We report the nationwide experience with solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients diagnosed with coronavirus disease 2019 (COVID-19) in Spain until 13 July 2020. We compiled information for 778 (423 kidney, 113 HSCT, 110 liver, 69 heart, 54 lung, 8 pancreas, 1 multivisceral) recipients. Median age at diagnosis was 61 years (interquartile range [IQR]: 52-70), and 66% were male. The incidence of COVID-19 in SOT recipients was two-fold higher compared to the Spanish general population. The median interval from transplantation was 59 months (IQR: 18-131). Infection was hospital-acquired in 13% of cases. No donor-derived COVID-19 was suspected. Most patients (89%) were admitted to the hospital. Therapies included hydroxychloroquine (84%), azithromycin (53%), protease inhibitors (37%), and interferon-β (5%), whereas immunomodulation was based on corticosteroids (41%) and tocilizumab (21%). Adjustment of immunosuppression was performed in 85% of patients. At the time of analysis, complete follow-up was available from 652 patients. Acute respiratory distress syndrome occurred in 35% of patients. Ultimately, 174 (27%) patients died. In univariate analysis, risk factors for death were lung transplantation (odds ratio [OR]: 2.5; 95% CI: 1.4-4.6), age >60 years (OR: 3.7; 95% CI: 2.5-5.5), and hospital-acquired COVID-19 (OR: 3.0; 95% CI: 1.9-4.9).

Keywords: antibiotic: antiviral; clinical decision-making; clinical research/practice; complication: infectious; infection and infectious agents - viral; infectious disease.

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Figures

FIGURE 1
FIGURE 1
Evolution of notified cases of COVID-19 in solid organ and hematopoietic stem cell transplant recipients according to presenting date
FIGURE 2
FIGURE 2
Adjustment of baseline immunosuppression in solid organ transplant recipients with COVID-19. mTOR inh, mammalian target of rapamycin inhibitors [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Kaplan-Meier survival curves in solid organ and hematopoietic stem cell transplant recipients with COVID-19: according to the transplant type (a), recipient age (b), hospital-acquired SARS-CoV-2 infection (c),and development of acute respiratory distress syndrome (d) (log-rank test for comparisons) [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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