Risk factors for unfavorable outcome and impact of early post-transplant infection in solid organ recipients with COVID-19: A prospective multicenter cohort study

Abstract

The aim was to analyze the characteristics and predictors of unfavorable outcomes in solid organ transplant recipients (SOTRs) with COVID-19. We conducted a prospective observational cohort study of 210 consecutive SOTRs hospitalized with COVID-19 in 12 Spanish centers from 21 February to 6 May 2020. Data pertaining to demographics, chronic underlying diseases, transplantation features, clinical, therapeutics, and complications were collected. The primary endpoint was a composite of intensive care unit (ICU) admission and/or death. Logistic regression analyses were performed to identify the factors associated with these unfavorable outcomes. Males accounted for 148 (70.5%) patients, the median age was 63 years, and 189 (90.0%) patients had pneumonia. Common symptoms were fever, cough, gastrointestinal disturbances, and dyspnea. The most used antiviral or host-targeted therapies included hydroxychloroquine 193/200 (96.5%), lopinavir/ritonavir 91/200 (45.5%), and tocilizumab 49/200 (24.5%). Thirty-seven (17.6%) patients required ICU admission, 12 (5.7%) suffered graft dysfunction, and 45 (21.4%) died. A shorter interval between transplantation and COVID-19 diagnosis had a negative impact on clinical prognosis. Four baseline features were identified as independent predictors of intensive care need or death: advanced age, high respiratory rate, lymphopenia, and elevated level of lactate dehydrogenase. In summary, this study presents comprehensive information on characteristics and complications of COVID-19 in hospitalized SOTRs and provides indicators available upon hospital admission for the identification of SOTRs at risk of critical disease or death, underlining the need for stringent preventative measures in the early post-transplant period.

Sex and organ-specific risk of major adverse renal or cardiac events in solid organ transplant recipients with COVID-19

“… 31 A much smaller cohort study of Spanish SOT recipients failed to demonstrate any organ‐specific differences in COVID‐19 outcomes; however, included less than 100 liver, lung, and heart recipients combined and was thus underpowered for this comparison. 32 …”

COVID-19 and kidney disease: insights from epidemiology to inform clinical practice

“…Several studies found mortality of >30% among transplant recipients in the acute phase following transplantation. This high mortality may be a consequence of aggressive immunosuppression and/or more frequent health-care interactions in the early post-transplantation period 21 , 44 , 57 , 63 . In one large centre in London, a mortality of 24% was found among kidney recipients — including seropositive patients — in their first year after transplantation compared with just 7% among those on the waiting list 45 .…”

Impact of early interferon-β treatment on the prognosis of patients with COVID-19 in the first wave: A post hoc analysis from a multicenter cohort

“…In the crude analysis, the EIT group showed higher mortality, as it was administered to patients with more severe disease. After adjustment for other well-known risk mortality predictors [15] , [30] , [31] , EIT was not found to be associated with mortality.…”