Outcomes following SARS-CoV-2 infection in individuals with and without solid organ transplantation-A Danish nationwide cohort study

Abstract

The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, hospitalization and death, and the effects of SARS-CoV-2 vaccines in solid organ transplant recipients (SOTRs) is still debated. We performed a nationwide, population-based, matched cohort study, including all Danish SOTRs (n = 5184) and a matched cohort from the general population (n = 41 472). Cox regression analyses were used to calculate incidence rate ratios (IRRs). SOTRs had a slightly increased risk of SARS-CoV-2 infection and were vaccinated earlier than the general population. The overall risk of hospital contact with COVID-19, severe COVID-19, need for assisted respiration, and hospitalization followed by death was substantially higher in SOTRs (IRR: 32.8 95%CI [29.0-37.0], 9.2 [6.7-12.7], 12.5 [7.6-20.8], 12.4 [7.9-12.7]). The risk of hospitalization and death after SARS-CoV-2 infection decreased substantially in SOTRs after the emergence of the Omicron variant (IRR: 0.45 [0.37-0.56], 0.17 [0.09-0.30]). Three vaccinations reduced the risk of SARS-CoV-2 infection only marginally compared to two vaccinations, but SOTRs with three vaccinations had a lower risk of death (IRR: 022 [0.16-0.35]). We conclude that SOTRs have a risk of SARS-CoV-2 infection comparable to the general population, but substantially increased the risk of hospitalization and death following SARS-CoV-2 infection. A third vaccination only reduces the risk of SARS-CoV2 infection marginally, but SOTRs vaccinated 3 times have reduced mortality.

Keywords: clinical research/practice; infection and infectious agents - viral; infection and infectious agents - viral: SARS-CoV-2/COVID-19; infectious disease; solid organ transplantation.

FIGURE 1

(A) Time to first and second positive test for SARS-CoV-2; black line: SOTRs, gray line: population controls, solid line: first positive test, dotted line: second positive test, time starts March 1, 2020 and ends May 1, 2022. (B) Time to second and third vaccination for SARS-CoV-2: black line: SOTR, gray line: population controls, solid line: second vaccination, dotted line: third vaccination, time starts January 1, 2021 and ends May 1, 2022. [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Time to (A) the first hospitalization with a COVID-19 diagnosis, (B) hospitalization with severe COVID-19, (C) hospitalization with assisted ventilation, (D) hospitalization with COVID-19 leading to death within 90 days (outcomes described in detail in methods), (E) time to hospitalization ≥24 h after first positive SARS-CoV-2 test, (F) time to death after first positive SARS-CoV-2 test. Solid line: SOTR; dotted line: population controls. Time starts on March 1, 2020 or the date of a positive test for SARS-CoV-2, respectively. [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 3

Time to (A) first positive SARS-CoV-2 test, (B) the first hospitalization with COVID-19, and (C) death for SOTRs before and after getting fully vaccinated (14 days after second vaccination or third vaccination). Dotted line: time with two vaccinations, full line: time with three vaccinations. Time starts on October 1, 2021 and ends May 1, 2022. [Color figure can be viewed at wileyonlinelibrary.com]