Clinical Characteristics and Outcomes of COVID-19 in Solid Organ Transplant Recipients

A Cohort Study

Zohra S. Chaudhry; Jonathan D. Williams; Amit Vahia; Raef Fadel; Tommy Parraga Acosta; Rohini Prashar; Pritika Shrivastava; Nadeen Khoury; Julio Pinto Corrales; Celeste Williams; Shunji Nagai; Marwan Abouljoud; Milagros Samaniego-Picota; Odaliz Abreu-Lanfranco; Ramon del Busto; Mayur S. Ramesh; Anita Patel; George J. Alangaden

Disclosures

American Journal of Transplantation. 2020;20(11):3051-3060. 

In This Article

Abstract and Introduction

Abstract

Solid organ transplant recipients (SOTr) with coronavirus disease 2019 (COVID-19) are expected to have poorer outcomes compared to nontransplant patients because of immunosuppression and comorbidities. The clinical characteristics of 47 SOTr (38 kidneys and 9 nonkidney organs) were compared to 100 consecutive hospitalized nontransplant controls. Twelve of 47 SOTr managed as outpatients were subsequently excluded from the outcome analyses to avoid potential selection bias. Chronic kidney disease (89% vs 57% P = .0007), diabetes (66% vs 33% P = .0007), and hypertension (94% vs 72% P = .006) were more common in the 35 hospitalized SOTr compared to controls. Diarrhea (54% vs 17%, P < .0001) was more frequent in SOTr. Primary composite outcome (escalation to intensive care unit, mechanical ventilation, or in-hospital all-cause mortality) was comparable between SOTr and controls (40% vs 48%, odds ratio [OR] 0.72 confidence interval [CI] [0.33–1.58] P = .42), despite more comorbidities in SOTr. Acute kidney injury requiring renal replacement therapy occurred in 20% of SOTr compared to 4% of controls (OR 6 CI [1.64–22] P = .007). Multivariate analysis demonstrated that increasing age and clinical severity were associated with mortality. Transplant status itself was not associated with mortality.

Introduction

In December 2019, a cluster of patients with acute respiratory illness of unknown origin was reported from the city of Wuhan, Hubei province, China. It was determined that the causative agent was a novel coronavirus—severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[1,2] As of May 15, 2020, the United States has over 1.4 million confirmed cases of coronavirus disease 2019 (COVID-19) and 85 000 deaths.[3] This has created unprecedented challenges to healthcare systems across the United States particularly, in large urban areas such as in Detroit, Michigan, which has 50 079 confirmed cases and 4 825 deaths.[4] Most patients will have mild illness, but older persons and those with comorbidities may develop severe disease necessitating hospitalization and escalation of care to the intensive care unit (ICU). The epidemiology, clinical characteristics, and outcomes of COVID-19 among solid organ transplant (SOT) recipients are undefined. Few early descriptive case reports and case series of SOT recipients with COVID-19 suggest poor outcomes; however, it is unknown if this is different from COVID-19 in the nontransplant population.[5,6] We report a comparative cohort study of 47 SOT recipients and 100 nontransplant patients diagnosed with COVID-19. The clinical features, severity of disease, and outcomes of the hospitalized SOT recipients and non-SOT patients with COVID-19 were compared.

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