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. 2021 Jul;21(7):2498-2508.
doi: 10.1111/ajt.16431. Epub 2021 Feb 21.

Inpatient COVID-19 outcomes in solid organ transplant recipients compared to non-solid organ transplant patients: A retrospective cohort

Robin K Avery  1 , Teresa Po-Yu Chiang  2 , Kieren A Marr  1 , Daniel C Brennan  1   3 , Afrah S Sait  1 , Brian T Garibaldi  1 , Pali Shah  1   3 , Darin Ostrander  1 , Seema Mehta Steinke  1 , Nitipong Permpalung  1 , Willa Cochran  3 , Martin A Makary  2 , Jacqueline Garonzik-Wang  2 , Dorry L Segev  2   4 , Allan B Massie  2   4
Affiliations

Inpatient COVID-19 outcomes in solid organ transplant recipients compared to non-solid organ transplant patients: A retrospective cohort

Robin K Avery et al. Am J Transplant. 2021 Jul.

Abstract

Immunosuppression and comorbidities might place solid organ transplant (SOT) recipients at higher risk from COVID-19, as suggested by recent case series. We compared 45 SOT vs. 2427 non-SOT patients who were admitted with COVID-19 to our health-care system (March 1, 2020 - August 21, 2020), evaluating hospital length-of-stay and inpatient mortality using competing-risks regression. We compared trajectories of WHO COVID-19 severity scale using mixed-effects ordinal logistic regression, adjusting for severity score at admission. SOT and non-SOT patients had comparable age, sex, and race, but SOT recipients were more likely to have diabetes (60% vs. 34%, p < .001), hypertension (69% vs. 44%, p = .001), HIV (7% vs. 1.4%, p = .024), and peripheral vascular disorders (19% vs. 8%, p = .018). There were no statistically significant differences between SOT and non-SOT in maximum illness severity score (p = .13), length-of-stay (sHR: 0.9 1.11.4 , p = .5), or mortality (sHR: 0.1 0.41.6 , p = .19), although the severity score on admission was slightly lower for SOT (median [IQR] 3 [3, 4]) than for non-SOT (median [IQR] 4 [3-4]) (p = .042) Despite a higher risk profile, SOT recipients had a faster decline in disease severity over time (OR = 0.76 0.810.86 , p < .001) compared with non-SOT patients. These findings have implications for transplant decision-making during the COVID-19 pandemic, and insights about the impact of SARS-CoV-2 on immunosuppressed patients.

Keywords: clinical research / practice; complication: infectious; infection and infectious agents - viral; infectious disease; organ transplantation in general.

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Figures

FIGURE 1
FIGURE 1
Distribution of maximum WHO severity score at presentation and during the entire admission, comparing SOT to non-SOT
FIGURE 2
FIGURE 2
Mean and standard error of daily WHO severity score throughout admission, comparing SOT to non-SOT
FIGURE 3
FIGURE 3
White blood cell count during COVID-19 admission, comparing SOT to non-SOT patients: (A) total WBC count, (B) absolute neutrophil count, (C) absolute lymphocyte count
FIGURE 4
FIGURE 4
Cumulative incidence of inpatient mortality and alive-at-discharge comparing SOT to non-SOT patients, competing risks framework. (A) Cumulative incidence of inpatient mortality. (B) Cumulative incidence of alive-at-discharge
See this image and copyright information in PMC

Comment in

  • COVID-19 in SOT versus non-SOT.
    Allam SR, Fisher AM, Schlauch D. Allam SR, et al. Am J Transplant. 2021 Jun;21(6):2304-2305. doi: 10.1111/ajt.16481. Epub 2021 Feb 8. Am J Transplant. 2021. PMID: 33387393 Free PMC article. No abstract available.

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