TY - JOUR
T1 - Inpatient COVID-19 outcomes in solid organ transplant recipients compared to non-solid organ transplant patients
T2 - A retrospective cohort
AU - Avery, Robin K.
AU - Chiang, Teresa Po Yu
AU - Marr, Kieren A.
AU - Brennan, Daniel C.
AU - Sait, Afrah S.
AU - Garibaldi, Brian T.
AU - Shah, Pali
AU - Ostrander, Darin
AU - Steinke, Seema Mehta
AU - Permpalung, Nitipong
AU - Cochran, Willa
AU - Makary, Martin A.
AU - Garonzik-Wang, Jacqueline
AU - Segev, Dorry L.
AU - Massie, Allan B.
N1 - Publisher Copyright:
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.
PY - 2021/7
Y1 - 2021/7
N2 - 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: 0.91.11.4, p =.5), or mortality (sHR: 0.10.41.6, 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 = 0.760.810.86, 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.
AB - 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: 0.91.11.4, p =.5), or mortality (sHR: 0.10.41.6, 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 = 0.760.810.86, 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.
KW - clinical research / practice
KW - complication: infectious
KW - infection and infectious agents - viral
KW - infectious disease
KW - organ transplantation in general
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U2 - 10.1111/ajt.16431
DO - 10.1111/ajt.16431
M3 - Article
C2 - 33284498
AN - SCOPUS:85100562238
SN - 1600-6135
VL - 21
SP - 2498
EP - 2508
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 7
ER -