Long‐term outcomes after COVID‐19 infection in transplant recipients

Abstract

BackgroundLong‐term outcomes after COVID‐19 infection unique to solid organ transplant recipients (SOTR) are not published. We describe outcomes including readmission, allograft rejection, allograft dysfunction, allograft failure, and death.MethodsWe conducted a retrospective cohort study of mostly unvaccinated SOTR with COVID‐19 from March 2020 to November 2021. Disease severity was assigned by NIH criteria. Data included demographics, clinical features, treatment, and outcomes and are presented as mean ± standard deviation or median (range).ResultsOne hundred and thirty‐eight SOTR were diagnosed with COVID‐19 at a median of 5 (IQR 3–8) years post‐transplant with a mean age of 57 ± 12 years at diagnosis. Forty‐one recovered at home; 97 were admitted. 12/32 (37.5%) SOTR with critical disease expired during initial admission. Among those who recovered, 48/126 (38.0%) had asymptomatic or mild infection, 31/126 (24.6%) had moderate, 27/126 (21.4%) severe, and 20/126 (15.9%) critical infection. 38/85 (44.7%) of SOTR who survived initial admission had 74 readmissions within 180 days (Figure 1). The 6‐month mortality rate among those who survived infection was 4/126 (3.2%). The mean time from initial infection to death was 32 ± 66 days in inpatient deaths and 95 ± 39 days in those who were discharged or never admitted. Six‐month graft dysfunction occurred in 18/125 (14.4%) and graft failure in 9/126 (7.2%); five failures were deaths with function.ConclusionReadmissions after COVID‐19 infection were frequent after the index admission. Rejection was relatively infrequent; graft dysfunction at 6 months post‐infection was more common than rejection. Six‐month mortality following COVID‐19 recovery in SOTR was significant; close follow‐up of patients is warranted.