COVID-19 in hospitalized lung and non-lung solid organ transplant recipients: A comparative analysis from a multicenter study

Abstract

Lung transplant recipients (LTR) with coronavirus disease 2019 (COVID-19) may have higher mortality than non-lung solid organ transplant recipients (SOTR), but direct comparisons are limited. Risk factors for mortality specifically in LTR have not been explored. We performed a multicenter cohort study of adult SOTR with COVID-19 to compare mortality by 28 days between hospitalized LTR and non-lung SOTR. Multivariable logistic regression models were used to assess comorbidity-adjusted mortality among LTR vs. non-lung SOTR and to determine risk factors for death in LTR. Of 1,616 SOTR with COVID-19, 1,081 (66%) were hospitalized including 120/159 (75%) LTR and 961/1457 (66%) non-lung SOTR (p = .02). Mortality was higher among LTR compared to non-lung SOTR (24% vs. 16%, respectively, p = .032), and lung transplant was independently associated with death after adjusting for age and comorbidities (aOR 1.7, 95% CI 1.0-2.6, p = .04). Among LTR, chronic lung allograft dysfunction (aOR 3.3, 95% CI 1.0-11.3, p = .05) was the only independent risk factor for mortality and age >65 years, heart failure and obesity were not independently associated with death. Among SOTR hospitalized for COVID-19, LTR had higher mortality than non-lung SOTR. In LTR, chronic allograft dysfunction was independently associated with mortality.

Keywords: clinical research/practice; infection and infectious agents - viral; infectious disease; lung (allograft) function/dysfunction; lung disease: infectious; lung transplantation/pulmonology; organ transplantation in general.

FIGURE 1

Unadjusted Kaplan–Meier curves for all-cause mortality within 28-days after COVID-19 diagnosis for hospitalized solid organ transplant recipients. Abbreviation: solid organ transplant recipients (SOTR). Note: Lung includes 1 lung/liver and 2 heart/lung recipients. Heart includes 14 heart/kidney and 1 heart/kidney/small bowel recipients. Liver includes 33 liver/kidney, 2 liver/pancreas/small bowel. Kidney includes 17 kidney/pancreas recipients. Recipients of other organs (1 vascular composite allograft and 2 small bowel recipients) not included [Color figure can be viewed at wileyonlinelibrary.com]