COVID-19 in Solid Organ Transplantation: A Matched Retrospective Cohort Study and Evaluation of Immunosuppression Management

Abstract

Background. The epidemiological and clinical characteristics of solid organ transplant (SOT) patients during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic remains unclear. We conducted a matched retrospective cohort study to compare clinical outcomes among SOT recipients with the general population and to assess immunosuppression management. Methods. Adult SOT recipients with laboratory polymerase chain reaction-confirmed SARS-CoV-2 infection admitted to a tertiary-care hospital in Barcelona, Spain, from March 11 to April 25, 2020, were matched to controls (1:4) on the basis of sex, age, and age-adjusted Charlson's Index. Patients were followed for up to 28 days from admission or until censored. Primary endpoint was mortality at 28 days. Secondary endpoints included admission to the intensive care unit and secondary complications. Drug-drug interactions (DDI) between immunosuppressants and coronavirus disease 2019 (COVID-19) management medication were collected. Results. Forty-six transplant recipients and 166 control patients were included. Mean (SD) age of transplant recipients and controls was 62.7 (12.6) and 66.0 (12.7) years, 33 (71.7%) and 122 (73.5%) were male, and median (interquartile range) Charlson's Index was 5 (3-7) and 4 (2-7), respectively. Mortality was 37.0% in SOT recipients and 22.9% in controls (P = 0.51). Thirty-three (71.7%) patients underwent transitory discontinuation of immunosuppressants due to potential or confirmed DDI. Conclusions. In conclusion, hospitalized SOT recipients with COVID-19 had a trend toward higher mortality compared with controls, although it was not statistically significant, and a notable propensity for DDI.

COVID-19: biologic and immunosuppressive therapy in gastroenterology and hepatology

“…By contrast, a study of 21 SOT recipients diagnosed with COVID-19 demonstrated favourable short-term outcomes, with less than 10% mortality, but highlighted that 50% required treatment at intensive care units and that those with concomitant infections had more severe illness 106 . Finally, a Spanish observational study in 46 adult SOT recipients with SARS-CoV-2 infection reported a higher mortality in SOT recipients compared with matched controls (37 versus 23%) 107 . In this study, 72% of patients underwent transitory discontinuation of immunosuppressants due to potential or confirmed drug–drug interactions.…”

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

“…18,19 However, our main finding of higher mortality among hospitalized SOT recipients is in contrast to results from similar publications. [20][21][22][23][24] We speculate that differences in inclusion criteria for patient enrollment across studies, such as severity of disease and type of organ transplant, as well as study limitations due to small sample size of SOT cohorts and degree of matching to a control group are contributing to variable findings in these reports.…”

“…Several studies each with <50 SOT recipients found no significant association between prior SOT and mortality, with one study detecting a trend toward higher mortality in SOT recipients. 20,21,23 These studies were largely limited by small sample sizes and underpowered statistical analyses. Two studies with larger SOT cohorts used propensity score matching to evaluate outcomes between SOT and non-SOT patients; however, findings are limited in generalizability.…”

“…19 Few studies have compared clinical characteristics and outcomes among SOT recipients and matched non-SOT control groups, which is critical to appropriately ascertain risk of mortality in this population. [20][21][22][23][24] Results from these studies have been conflicting or non-significant regarding association between SOT status and mortality, with three reports concluding risk of mortality is similar in both transplant and non-transplant patients with COVID-19. 20,21,23 It is important to note that the source populations and endpoints differ across these studies, which poses a challenge to generalizability of results.…”

“…[20][21][22][23][24] Results from these studies have been conflicting or non-significant regarding association between SOT status and mortality, with three reports concluding risk of mortality is similar in both transplant and non-transplant patients with COVID-19. 20,21,23 It is important to note that the source populations and endpoints differ across these studies, which poses a challenge to generalizability of results. However, results from these studies suggest that a large source population from which to sample the matched non-SOT cohort is required to make firm conclusions.…”