Outcomes of COVID‐19 in solid organ transplant recipients: A matched cohort study

Pereira, Marcus R.; Arcasoy, Selim M.; Farr, Maryjane; Mohan, Sumit; Emond, Jean C.; Zheng, Elizabeth; Shi, Qiuhu; Purpura, Lawrence; Uhlemann, Anne Catrin; Zucker, Jason; Verna, Elizabeth C.

doi:10.1111/tid.13637

Cited by 49 publications

(63 citation statements)

References 29 publications

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“…Solid organ transplant recipients (SOTR) are at risk of severe disease and high mortality from COVID‐19 but the data are unfolding and complicated. 4 , 5 Earlier observational studies reported a much higher mortality rate in transplant recipients with COVID‐19 infection compared to the general population. 6 , 7 , 8 However, several studies have suggested that short‐term mortality in SOTR from COVID‐19 is similar to immunocompetent patients, with the postulated reason being protection by blunting of the immune responses due to chronic immunosuppression.…”

Section: Introductionmentioning

confidence: 99%

Kidney transplant recipients’ attitudes toward COVID‐19 vaccination and barriers and enablers to vaccine acceptance

Tharmaraj

Dendle

Polkinghorne

et al. 2021

Transplant Infectious Dis

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Objective To identify barriers and enablers to COVID‐19 vaccination in renal transplant recipients who are undecided about vaccination. Methods An online survey was distributed to 876 adult kidney transplant recipients at a tertiary referral service, who had not been vaccinated against COVID‐19. The survey assessed willingness to be vaccinated, attitudes toward COVID‐19 vaccines, and barriers and enablers to proceeding with vaccination. Results The survey response rate was 54% (473/876). Three hundred and forty‐six (73.1%) participants planned to receive vaccination (yes group), 105 (22.2%) were undecided, and 22 (4.7%) refused vaccination. The undecided group were younger but were not different in other demographic characteristics to the yes group. The undecided group were less positive toward (34.29% vs. 91.3%, p < .001) and more concerned about (93.3% vs. 25.1%, p < .001) vaccination than the yes group. Their concerns related to vaccine safety (including harm to their transplant), poor efficacy, and a lack of rigorous testing in transplant recipients. Undecided recipients had received less vaccine‐specific information from medical specialists than the yes group. Most undecided participants (95.1%) were willing to proceed with vaccination with appropriate supports. The most desired supports were information and a recommendation to proceed with vaccination from their treating transplant specialist and team. Conclusion(s) Concerns about vaccine safety (including harm to transplant), poor vaccine efficacy, and lack of rigorous testing were barriers to vaccine uptake. Most undecided recipients would proceed with vaccination with specific recommendations and vaccine information provided by their transplant specialist/team. These simple interventions can be readily implemented to optimize vaccine uptake.

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Section: Introductionmentioning

confidence: 99%

Kidney transplant recipients’ attitudes toward COVID‐19 vaccination and barriers and enablers to vaccine acceptance

Tharmaraj

Dendle

Polkinghorne

et al. 2021

Transplant Infectious Dis

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“…In a recent study of 482 SOT recipients who were hospitalized for COVID-19, the mortality rate was 20.5%, which was more related to age and underlying comorbidities than to immunosuppression intensity-related factors [ 17 ]. Another matched cohort study also showed that SOT recipients who were hospitalized with COVID-19 had similar outcomes as non-SOT patients [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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

Dęborska−Materkowska

Kamińska

2021

Viruses

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Since its outbreak in December 2019, the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), led to an enormous rise in scientific response with an excess of COVID-19-related studies on the pathogenesis and potential therapeutic approaches. Solid organ transplant (SOT) recipients are a heterogeneous population with long-lasting immunosuppression as a joining element. Immunocompromised patients are a vulnerable population with a high risk of severe infections and an increased infection-related mortality rate. It was postulated that the hyperinflammatory state due to cytokine release syndrome during severe COVID-19 could be alleviated by immunosuppressive therapy in SOT patients. On the other hand, it was previously established that T cell-mediated immunity, which is significantly weakened in SOT recipients, is the main component of antiviral immune responses. In this paper, we present the current state of science on COVID-19 immunology in relation to solid organ transplantation with prospective therapeutic and vaccination strategies in this population.

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“…Discarding the studies that analyzed a single organ type of transplant and hematopoietic transplant, most of them demonstrate high mortality rates [ 17 – 24 ]. However, it is noteworthy that some of these studies did not compare their results with the non-transplanted population [ 17 – 20 ], while others did not find such high mortality rates or any differences compared with the non-transplanted population [ 16 , 25 – 30 ]. Mortality rates in these series were affected by age, number of underlying comorbidities, and by the population analyzed (hospitalized patients only [ 16 , 21 , 24 , 30 ] or also outpatients [ 17 – 20 , 22 – 23 , 25 – 28 ]).…”

Section: Discussionmentioning

confidence: 99%

Coronavirus Disease 2019 (COVID-19) in Solid Organ Transplant Recipients: A Case-Control Study

et al. 2021

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Background It is unclear whether solid organ transplant (SOT) patients have more severe coronavirus disease 2019 (COVID-19) and worse outcome than the general population. Material/Methods We conducted a case-control study on 32 SOT recipients and 84 non-SOT controls matched for age and sex admitted for confirmed COVID-19. The primary endpoint was in-hospital all-cause mortality rate. Secondary endpoints included severe acute respiratory distress syndrome (ARDS), use of high-flow oxygen therapy, and length of hospital stay. Results The median (IQR) Charlson comorbidity index (CCI) at admission was significantly higher in SOT recipients (6 (3–8) vs 3 (2–4); P <0.01). Fever was less frequent in SOT recipients (78% vs 94%, P =0.01). SOT recipients had a higher median SaO2/FiO2 at admission (452 [443–462] vs 443 [419–452], P <0.01) and reached the worst SaO2/FiO2 value later during hospitalization 15 (10–21) vs 11 (9–14) days, P =0.01). Both groups had a similar severe ARDS rate during hospitalization (33% vs 28%) (p=0.59). There were no significant differences during hospitalization in terms of highest level of respiratory support needed, or length of hospital stay: 8.5 (5.5–21) vs 11.5 (6.5–16.5) days; P =0.34) in SOT recipients when compared to controls. In-hospital all-cause mortality rates were significantly higher in SOT recipients (21.9% vs 4.7%, P <0.01; OR 1.08; 95% CI 0.10–10.98), but among patients who died, median CCI was similar between groups (8 [ 6 – 8 ] vs 7 [ 6 – 8 ]). Conclusions In our experience, hospitalized SOT recipients for COVID-19 had higher in-hospital mortality compared to non-SOT patients, probably due to the greater number of underlying comorbidities, and not directly related to chronic immunosuppression.

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Outcomes of COVID‐19 in solid organ transplant recipients: A matched cohort study

Cited by 49 publications

References 29 publications

Kidney transplant recipients’ attitudes toward COVID‐19 vaccination and barriers and enablers to vaccine acceptance

Kidney transplant recipients’ attitudes toward COVID‐19 vaccination and barriers and enablers to vaccine acceptance

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

Coronavirus Disease 2019 (COVID-19) in Solid Organ Transplant Recipients: A Case-Control Study

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