TY - JOUR
T1 - Coronavirus Disease 2019 in Solid Organ Transplant
T2 - A Multicenter Cohort Study
AU - the UW COVID-19 SOT Study Team
AU - Kates, Olivia S.
AU - Haydel, Brandy M.
AU - Florman, Sander S.
AU - Rana, Meenakshi M.
AU - Chaudhry, Zohra S.
AU - Ramesh, Mayur S.
AU - Safa, Kassem
AU - Kotton, Camille Nelson
AU - Blumberg, Emily A.
AU - Besharatian, Behdad D.
AU - Tanna, Sajal D.
AU - Ison, Michael G.
AU - Malinis, Maricar
AU - Azar, Marwan M.
AU - Rakita, Robert M.
AU - Morilla, Jose A.
AU - Majeed, Aneela
AU - Sait, Afrah S.
AU - Spaggiari, Mario
AU - Hemmige, Vagish
AU - Mehta, Sapna A.
AU - Neumann, Henry
AU - Badami, Abbasali
AU - Goldman, Jason D.
AU - Lala, Anuradha
AU - Hemmersbach-Miller, Marion
AU - McCort, Margaret E.
AU - Bajrovic, Valida
AU - Ortiz-Bautista, Carlos
AU - Friedman-Moraco, Rachel
AU - Sehgal, Sameep
AU - Lease, Erika D.
AU - Fisher, Cynthia E.
AU - Limaye, Ajit P.
AU - Arya, Akanksha
AU - Jeng, Amy
AU - Kuo, Alexander
AU - Luk, Alfred
AU - Puing, Alfredo G.
AU - Rossi, Ana P.
AU - Brueckner, Andrew J.
AU - Multani, Ashrit
AU - Keller, Brian C.
AU - Derringer, Darby
AU - Florescu, Diana F.
AU - Dominguez, Edward A.
AU - Sandoval, Elena
AU - Bilgili, Erin P.
AU - Hashim, Faris
AU - Silveira, Fernanda P.
N1 - Publisher Copyright:
© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].
PY - 2021
Y1 - 2021
N2 - Background. The coronavirus disease 2019 (COVID-19) pandemic has led to significant reductions in transplantation, motivated in part by concerns of disproportionately more severe disease among solid organ transplant (SOT) recipients. However, clinical features, outcomes, and predictors of mortality in SOT recipients are not well described. Methods. We performed a multicenter cohort study of SOT recipients with laboratory-confirmed COVID-19. Data were collected using standardized intake and 28-day follow-up electronic case report forms. Multivariable logistic regression was used to identify risk factors for the primary endpoint, 28-day mortality, among hospitalized patients. Results. Four hundred eighty-two SOT recipients from >50 transplant centers were included: 318 (66%) kidney or kidney/pancreas, 73 (15.1%) liver, 57 (11.8%) heart, and 30 (6.2%) lung. Median age was 58 (interquartile range [IQR] 46-57), median time post-transplant was 5 years (IQR 2-10), 61% were male, and 92% had ≥1 underlying comorbidity. Among those hospitalized (376 [78%]), 117 (31%) required mechanical ventilation, and 77 (20.5%) died by 28 days after diagnosis. Specific underlying comorbidities (age >65 [adjusted odds ratio [aOR] 3.0, 95% confidence interval [CI] 1.7-5.5, P <.001], congestive heart failure [aOR 3.2, 95% CI 1.4-7.0, P =.004], chronic lung disease [aOR 2.5, 95% CI 1.2-5.2, P =.018], obesity [aOR 1.9, 95% CI 1.0-3.4, P =.039]) and presenting findings (lymphopenia [aOR 1.9, 95% CI 1.1-3.5, P =.033], abnormal chest imaging [aOR 2.9, 95% CI 1.1-7.5, P =.027]) were independently associated with mortality. Multiple measures of immunosuppression intensity were not associated with mortality. Conclusions. Mortality among SOT recipients hospitalized for COVID-19 was 20.5%. Age and underlying comorbidities rather than immunosuppression intensity-related measures were major drivers of mortality.
AB - Background. The coronavirus disease 2019 (COVID-19) pandemic has led to significant reductions in transplantation, motivated in part by concerns of disproportionately more severe disease among solid organ transplant (SOT) recipients. However, clinical features, outcomes, and predictors of mortality in SOT recipients are not well described. Methods. We performed a multicenter cohort study of SOT recipients with laboratory-confirmed COVID-19. Data were collected using standardized intake and 28-day follow-up electronic case report forms. Multivariable logistic regression was used to identify risk factors for the primary endpoint, 28-day mortality, among hospitalized patients. Results. Four hundred eighty-two SOT recipients from >50 transplant centers were included: 318 (66%) kidney or kidney/pancreas, 73 (15.1%) liver, 57 (11.8%) heart, and 30 (6.2%) lung. Median age was 58 (interquartile range [IQR] 46-57), median time post-transplant was 5 years (IQR 2-10), 61% were male, and 92% had ≥1 underlying comorbidity. Among those hospitalized (376 [78%]), 117 (31%) required mechanical ventilation, and 77 (20.5%) died by 28 days after diagnosis. Specific underlying comorbidities (age >65 [adjusted odds ratio [aOR] 3.0, 95% confidence interval [CI] 1.7-5.5, P <.001], congestive heart failure [aOR 3.2, 95% CI 1.4-7.0, P =.004], chronic lung disease [aOR 2.5, 95% CI 1.2-5.2, P =.018], obesity [aOR 1.9, 95% CI 1.0-3.4, P =.039]) and presenting findings (lymphopenia [aOR 1.9, 95% CI 1.1-3.5, P =.033], abnormal chest imaging [aOR 2.9, 95% CI 1.1-7.5, P =.027]) were independently associated with mortality. Multiple measures of immunosuppression intensity were not associated with mortality. Conclusions. Mortality among SOT recipients hospitalized for COVID-19 was 20.5%. Age and underlying comorbidities rather than immunosuppression intensity-related measures were major drivers of mortality.
KW - COVID-19
KW - Coronavirus
KW - SARS-CoV-2
KW - Solid organ transplantation
KW - Transplantation
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U2 - 10.1093/cid/ciaa1097
DO - 10.1093/cid/ciaa1097
M3 - Article
C2 - 32766815
AN - SCOPUS:85122546552
SN - 1058-4838
VL - 73
SP - E4090-E4099
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 11
ER -