Outcomes of SOT Recipients With COVID-19 in Different Eras of COVID-19 Therapeutics

Abstract

Background: Few reports have focused on newer coronavirus disease 2019 (COVID-19) therapies (remdesivir, dexamethasone, and convalescent plasma) in solid organ transplant recipients; concerns had been raised regarding possible adverse impact on allograft function or secondary infections.

Methods: We studied 77 solid organ transplant inpatients with COVID-19 during 2 therapeutic eras (Era 1: March-May 2020, 21 patients; and Era 2: June-November 2020, 56 patients) and 52 solid organ transplant outpatients.

Results: In Era 1, no patients received remdesivir or dexamethasone, and 4 of 21 (19.4%) received convalescent plasma, whereas in Era 2, remdesivir (24/56, 42.9%), dexamethasone (24/56, 42.9%), and convalescent plasma (40/56, 71.4%) were commonly used. Mortality was low across both eras, 4 of 77 (5.6%), and rejection occurred in only 2 of 77 (2.8%) inpatients; infections were similar in hypoxemic patients with or without dexamethasone. Preexisting graft dysfunction was associated with greater need for hospitalization, higher severity score, and lower survival. Acute kidney injury was present in 37.3% of inpatients; renal function improved more rapidly in patients who received remdesivir and convalescent plasma. Post-COVID-19 renal and liver function were comparable between eras, out to 90 d.

Conclusions: Newer COVID-19 therapies did not appear to have a deleterious effect on allograft function, and infectious complications were comparable.

FIGURE 1.

Trajectories of serum creatinine (SCr) for solid organ transplant recipients hospitalized for coronavirus disease 2019, stratified by remdesivir use. A, Distribution of SCr by time since admission stratified by use/nonuse of remdesivir. B, Lowess plot of change over time in SCr for patients who received remdesivir stratified by days before/after initiation of treatment (normalized so that baseline SCr obtained before onset of illness = 0; eg, a value of 1 represents SCr 1 mg/dL higher than baseline). IQR, interquartile range.

FIGURE 2.

Trajectories of serum creatinine (SCr) for solid organ transplant recipients hospitalized for coronavirus disease 2019, stratified by convalescent plasma use. A, Distribution of SCr by time since admission stratified by use/nonuse of convalescent plasma. B, Lowess plot of change over time in SCr for patients who received convalescent plasma stratified by days before/after initiation of treatment (normalized so that baseline SCr obtained before onset of illness = 0; eg, a value of 1 represents SCr 1 mg/dL higher than baseline). IQR, interquartile range.

FIGURE 3.

Cumulative incidence of mortality and discharge for solid organ transplant recipients hospitalized for coronavirus disease 2019, stratified by presence of preexisting graft dysfunction. A, Mortality after hospital admission. B, Hospital discharge. sHR, subhazard ratio.

FIGURE 4.

Summarized trajectory of inpatient World Health Organization (WHO) severity scale, stratified by presence of preexisting graft dysfunction (mean and SE).