Coronavirus Disease 2019 in Solid Organ Transplant: A Multicenter Cohort Study
Authors: Kates Olivia S , Haydel Brandy M , Florman Sander S , Rana Meenakshi M , Chaudhry Zohra S , Ramesh Mayur S , Safa Kassem , Kotton Camille Nelson , Blumberg Emily A , Besharatian Behdad D , Tanna Sajal D , Ison Michael G , Malinis Maricar , Azar Marwan M , Rakita Robert M , Morilla Jose A , Majeed Aneela , Sait Afrah S , Spaggiari Mario , Hemmige Vagish , Mehta Sapna A , Neumann Henry , Badami Abbasali , Goldman Jason D , Lala Anuradha , Hemmersbach-Miller Marion , McCort Margaret E , Bajrovic Valida , Ortiz-Bautista Carlos , Friedman-Moraco Rachel , Sehgal Sameep , Lease Erika D , Fisher Cynthia E , Limaye Ajit P ,   UW COVID-19 SOT Study Team, Arya Akanksha , Jeng Amy , Kuo Alexander , Luk Alfred , Puing Alfredo G , Rossi Ana P , Brueckner Andrew J , Multani Ashrit , Keller Brian C , Derringer Darby , Florescu Diana F , Dominguez Edward A , Sandoval Elena , Bilgili Erin P , Hashim Faris , Silveira Fernanda P , Haidar Ghady , Joharji Hala G , Murad Haris F , Gani Imran Yaseen , el-amm Jose-Marie , Kahwaji Joseph , Popoola Joyce , Yabu Julie M , Hughes Kailey , Saharia Kapil K , Gajurel Kiran , Bowman Lyndsey J , Veroux Massimiliano , Morales Megan K , Fung Monica , Theodoropoulos Nicole M , de la Cruz Oveimar , Kapoor Rajan , La Hoz Ricardo M , Allam Sridhar R , Vora Surabhi B , McCarty Todd P , Anderson-Haag Tracy , Malhotra Uma , Kelly Ursula M , Bhandaram Vidya , Bennett William M , Lominadze Zurabi 
Published: August 2020

Abstract

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 &gt;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 &gt;65 [adjusted odds ratio [aOR] 3.0, 95% confidence interval [CI] 1.7–5.5, P &lt; .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.