Delayed Mortality Among Solid Organ Transplant Recipients Hospitalized for COVID-19
Authors: Heldman Madeleine R , Kates Olivia S , Safa Kassem , Kotton Camille N , Multani Ashrit , Georgia Sarah J , Steinbrink Julie M , Alexander Barbara D , Blumberg Emily A , Haydel Brandy , Hemmige Vagish , Hemmersbach-Miller Marion , La Hoz Ricardo M , Moni Lisset , Condor Yesabeli , Flores Sandra , Munoz Carlos G , Guitierrez Juan , Diaz Esther I , Diaz Daniela , Vianna Rodrigo , Guerra Giselle , Loebe Matthias , Yabu Julie M , Kramer Kailey Hughes , Tanna Sajal D , Ison Michael G , Rakita Robert M , Malinis Maricar , Azar Marwan M , McCort Margaret E , Singh Pooja P , Velioglu Arzu , Mehta Sapna A , van Duin David , Goldman Jason D , Lease Erika D , Wald Anna , Limaye Ajit P , Fisher Cynthia E ,   UW Covid-19 SOT Study Team, Besharatian Behdad D , Crespo Maria , Tomic Rade , Sehgal Sameep , Weisshaar Dana , Girgis Reda , Lawrence Cameron , Nelson Joanna , Bennett William , Leandro Jennifer , Sait Afrah , Rumore Amy , West Patricia , Jeng Amy , Bajrovic Valida , Bilgili Erin P , Anderson-Haag Tracy , Nastase Abigail , Badami Abbas , Alvarez-Garcia Jesus , Bowman-Anger Lyndsey , Julien Lovelyn , Ortiz-Bautista Carlos , Friedman-Morocco Rachel , Gajurel Kiran , Cahuayme-Zuniga Lizbeth , Wakefield Mark , Fung Monica , Theodoropoulos Nicole , Chuang Sally T , Bhandaram Srividya , Veroux Massimiliano , Chopra Bhavna , Florescu Diana , Witteck Danielle , Diaz Daniela , Ripley Kathryn , Saharia Kapil , Akkina Sanjeev , McCarty Todd P , Webb Ally , Arya Akanksha , Vedula Giridhar , El-Amm Jose-Marie , Dokus M Katherine , Narayanan Arun , de Camargo Priscila Cilene Leon Bueno , Ouseph Rosemary , Breuckner Andrew , Luk Alfred , Aujayeb Avinash , Ganger Daniel , Keith Douglas S , Meloni Federica , Haidar Ghady , Zapernick Lori , Morales Megan , Goyal Nitender , Sharma Tanvi , Malhotra Uma , Kuo Alexander , Rossi Ana P , Edwards Angelina , Keller Brian , Beneri Christy , Derringer Darby , Dominguez Edward , Carlson Elise , Hashim Faris , Murad Haris , Wilkens Heinrike , Neumann Henry , Gani Imran , Kahwaji Joseph , Popoola Joyce , Michaels Marian , Jakharia Niyati , De la Cruz Oveimar , Puing Alfredo , Motallebzadeh Reza , Velagapudi Ravi , Kapoor Rajan , Allam Sridhar , Silveira Fernanda , Vora Surabhi , Kelly Ursala M , Reddy Uttam , Dharnidharka Vikas , Wadei Hani , Zurabi Lominadze 
Published: February 2022

Abstract

Background
Most studies of solid organ transplant (SOT) recipients with coronavirus disease 2019 (COVID-19) focus on outcomes within 1 month of illness onset. Delayed mortality in SOT recipients hospitalized for COVID-19 has not been fully examined.

Methods
We used data from a multicenter registry to calculate mortality by 90 days following initial acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection in SOT recipients hospitalized for COVID-19 and developed multivariable Cox proportional hazards models to compare risk factors for death by days 28 and 90.

Results
Vital status at day 90 was available for 936 of 1117 (84%) SOT recipients hospitalized for COVID-19; 190 of 936 (20%) died by 28 days, and an additional 56 of 246 deaths (23%) occurred between days 29 and 90. Factors associated with mortality by day 90 included age &gt;65 years (adjusted hazard ratio [aHR], 1.8 [1.3–2.4]; P &lt;.001), lung transplant (vs nonlung transplant; aHR, 1.5 [1.0–2.3]; P = .05), heart failure (aHR, 1.9 [1.2–2.9]; P = .006), chronic lung disease (aHR, 2.3 [1.5–3.6]; P &lt; .001), and body mass index ≥30 kg/m2 (aHR, 1.5 [1.1–2.0]; P = .02). These associations were similar for mortality by day 28. Compared with diagnosis during early 2020 (1 March 2020–19 June 2020), diagnosis during late 2020 (20 June 2020–31 December 2020) was associated with lower mortality by day 28 (aHR, 0.7 [0.5–1.0]; P = .04) but not by day 90 (aHR, 0.9 [0.7–1.3]; P = .61).

Conclusions
In SOT recipients hospitalized for COVID-19, &gt;20% of deaths occurred between 28 and 90 days following SARS-CoV-2 diagnosis. Future investigations should consider extending follow-up duration to 90 days for more complete mortality assessment.