Response to “COVID-19 in SOT versus non-SOT” (2021)

To the Editor: We thank Drs. Allam, Fisher, and Schlauch for their thoughtful comments,1Allam SR, Fisher AM, Schlauch D. COVID-19 in SOT vs. non-SOT. Am J Transplant. 2021. https://doi.org/10.1111/ajt.16481.Google Scholar and we would like to offer the following responses. While 45 may be a small number, this does represent the number of SOT recipients with COVID-19 admitted to our health system through the end of August 2020, as recorded in the Johns Hopkins CROWN Registry. The large number of non-SOT patients (2427) in the registry provided an opportunity to make comparisons of interest. The 45 SOT recipients included 28 kidney, six liver, two liver/kidney, five lung, three heart, and one composite tissue allograft recipient. The registry data were provided in deidentified form, so time posttransplant was not readily accessible. We agree that data from a single health system may not be generalizable. We also agree that transplant recipients have close relationships with their transplant teams, and therefore may have more access to care; we had mentioned both of these considerations in the Limitations section of our paper. We also agree that differential use of targeted COVID-19 therapies might have made a difference in the rapidity of improvement as measured by the WHO severity scale. Regarding the question about the analysis, we did report subhazard ratios for length of stay and mortality in the weighted model which adjusted for age, sex, race, and oxygen requirement on Day 1: the subhazard ratios of mortality (sHR: 0.160.662.66, p = .56) and length of stay (sHR: 0.700.921.20, p = .53) in this weighted model did not alter our conclusions. We are aware that others have reported higher mortality in SOT recipients than in non-SOT patients, including a study just published by the authors of the letter to which we are responding.2Fisher AM Schlauch D Mulloy M et al.Outcomes of COVID-19 in hospitalized solid organ transplant recipients compared to a matched cohort of non-transplant patients at a national healthcare system in the United States.Clin Transplant. 2021; (https://doi.org/10.1111/ctr.14216.): e14216PubMed Google Scholar However, in our updated (unpublished) data on 72 SOT recipients admitted through November 30, 2020, we have continued to see a similarly low mortality. Chaudhry et al also found comparable outcomes in a comparison between SOT recipients and nontransplant patients.3Chaudhry ZS Williams JD Vahia A et al.Clinical characteristics and outcomes of COVID-19 in solid organ transplant recipients: a cohort study.Am J Transplant. 2020; 20: 3051-3060Abstract Full Text Full Text PDF PubMed Scopus (97) Google Scholar We feel that our study demonstrates that low case-fatality rates are achievable for SOT recipients, even among those who have been hospitalized for their illness. We agree with Dr. Allam and colleagues that the landscape of COVID-19 in SOT can best be understood by rigorous analyses drawing on different populations, geographic regions, and therapeutic approaches. We look forward to future studies from colleagues around the world which will continue to add to our collective knowledge. The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.