A retrospective matched cohort single‐center study evaluating outcomes of COVID‐19 and the impact of immunomodulation on COVID‐19‐related cytokine release syndrome in solid organ transplant recipients

Abstract

This retrospective matched cohort study describes 30 solid organ transplant (SOT) patients with Coronavirus Disease 2019 (COVID‐19) matched 1:2 to 60 non‐SOT patients (control group) based on age, body mass index (BMI), and comorbidities (hypertension and diabetes mellitus with hemoglobin A1c > 8.0%). The SOT group had a higher proportion of cardiovascular disease ( P < .05). During the index hospitalization, there were no significant differences with regard to disease severity or critical care needs (mechanical intubation, vasopressors, and renal replacement therapy). At 28 days, 4 (13%) patients died in the SOT group and 8 (13%) patients died in the control group ( P = 1.0). Nineteen patients received tocilizumab in the SOT group compared to 29 patients in the control group. Among these patients, interleukin‐6 (IL‐6) and soluble interleukin‐2 receptor (sIL2R) levels increased after tocilizumab and interleukin‐10 (IL‐10) levels decreased after tocilizumab. Overall, SOT patients had comparable mortality to non‐SOT patients, although numerically more SOT patients received tocilizumab (63% vs 48%) and steroids (37% vs 20%). Larger, multi‐center studies are needed to ascertain these findings. Lastly, the complex cytokine release syndrome in COVID‐19 remains an area of intense research and the analysis of key interleukin levels (IL‐6, IL‐10, and sIL2R) in this study contributes to the understanding of this process.

The Immunology of SARS-CoV-2 Infection and Vaccines in Solid Organ Transplant Recipients

“…In a retrospective matched cohort of 30 SOT recipients with COVID-19, the highest CRP, D-dimer, procalcitonin, and LDH levels did not differ from the non-transplant group. SOT patients with critical disease had higher IL-6 levels compared with those with moderate and severe disease [ 43 ]. Early elevations of CRP, hs-troponin I, D-dimer, and IL-6 were significantly associated with severe disease and mortality in KTRs [ 44 ].…”

SARS-CoV-2 infection in liver transplant recipients: A complex relationship

“…Transplantation is a treatment for organ failure and end-stage organ illnesses, requiring patients to undergo regular use of immunosuppressive treatment to avoid organ rejection[ 2 ]. There is no consensus regarding the increase in the incidence or severity of COVID-19 on solid organ transplant (SOT) recipients[ 3 ]. A few reports have identified an increase in severe COVID-19 and mortality rate in SOT recipients[ 4 , 5 ], while others failed to do so[ 3 , 6 ].…”

“…There is no consensus regarding the increase in the incidence or severity of COVID-19 on solid organ transplant (SOT) recipients[ 3 ]. A few reports have identified an increase in severe COVID-19 and mortality rate in SOT recipients[ 4 , 5 ], while others failed to do so[ 3 , 6 ].…”

COVID-19 Severity and Mortality in Solid Organ Transplantation: Differences between Liver, Heart, and Kidney Recipients

“…Previous reports have identified increased lethality in Transplantology 2021, 2 297 SOT recipients, comparing the survival rate with that of the general population, which could be influenced by the difference in treatments and associated comorbidities [9]. A case-controlled study concluded that SOT patients were not at greater risk during COVID-19, the immunosuppressive treatment did not influence the outcome of COVID-19 [10], and SOT patients did not present an increase in respiratory failure or cytokine production [11].…”