Outcomes for transplant recipients with COVID-19 found similar to general population
A study of patients hospitalized with COVID-19 across the United States showed little difference in outcomes between solid organ transplant recipients and the general population.
“Previously published studies focusing on [solid organ transplant] SOT patients and COVID-19 lack comparison with a control group to ascertain their risk as compared to the general population,” Miklos Z. Molnar, MD, PhD, of the James D. Eason Transplant Institute at Methodist University Hospital in Memphis, and colleagues wrote. “To address this knowledge gap, we compared outcomes in SOT versus non-SOT patients with COVID-19 who were admitted to intensive care units (ICUs) throughout the US, using data from a multicenter cohort study. We hypothesized that SOT patients would have similar risk of death and organ support requirement compared to non-SOT patients.”
For the study, Molnar and colleagues assessed patients from 68 hospitals, creating a propensity score-matched cohort of 386 patients. These included 98 SOT patients and 288 non-SOT patients with similar baseline characteristics (median age, 60 years; 72% were men; 41% were Black patients). Of the SOT group, 67 were kidney transplant recipients; 13 were liver transplant recipients; 13 were heart transplant recipients; four were lung transplant recipients; and one was a pancreas transplant recipient.
Patients were followed until the first of hospital discharge, death or June 5, 2020.
The primary outcome of the study was mortality within 28 days of ICU admission, which Molnar and colleagues found to be similar between SOT and non-SOT patients (40% and 43%, respectively; relative risk [RR]= 0.92).
In addition, the researchers found no differences between groups in the duration of ICU length of stay, risk of acute respiratory distress syndrome, secondary infection, thromboembolic events, vasopressor use, or receipt or duration of invasive mechanical ventilation.
They did, however, observed a trend toward higher risk of AKI requiring renal replacement therapy in SOT vs. non-SOT patients (37% vs. 27%; RR = 1.34).
“Previous experience with respiratory viruses suggests a higher mortality in SOT patients compared to non-SOT patients, yet we report no difference in the 28-day mortality risk in our cohort,” Molnar and colleagues wrote. “One potential explanation is that there was a higher use of corticosteroid treatment in SOT patients compared to non-SOT patients.”
They recommend future studies be conducted to examine the effect of specific immunosuppression and other therapeutic regimens on clinical outcomes.