Table 5.
Ninety-day and 1-year death/graft failure among solid organ transplant recipients diagnosed with COVID-19 within 30 days of transplant.
| Characteristics | (A) Death/graft failure: 90 days posttransplant | (B) Death/graft failure: 1-year posttransplant | ||||||
|---|---|---|---|---|---|---|---|---|
| Total N = 369 | No events, n = 355 | Events n = 14 | p-value | Total N = 326 | No events, n = 306 | Events n = 20 | p-value | |
| Demographics at the first reported COVID-19 episode | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | ||
| Age at encounter (years), median (IQR) | 54 (44–63) | 53 (44–63) | 57 (49–65) | 0.38 | 53.5 (44–63) | 53 (44–63) | 58 (51–67.5) | 0.072 |
| Gender | 0.99 | 0.48 | ||||||
| Female | 149 (40.4%) | 143 (40.3%) | 6 (42.9%) | 132 (40.5%) | 122 (39.9%) | 10 (50.0%) | ||
| Male | 220 (59.6%) | 212 (59.7%) | 8 (57.1%) | 194 (59.5%) | 184 (60.1%) | 10 (50.0%) | ||
| Race/ethnicity | 0.57 | 0.6 | ||||||
| Non-Hispanic White | 141 (38.2%) | 136 (38.3%) | 5 (35.7%) | 122 (37.4%) | 114 (37.3%) | 8 (40.0%) | ||
| Non-Hispanic Black | 88 (23.8%) | 83 (23.4%) | 5 (35.7%) | 83 (25.5%) | 76 (24.8%) | 7 (35.0%) | ||
| Non-Hispanic Asian | 39 (10.6%) | 37 (10.4%) | 2 (14.3%) | 32 (9.8%) | 30 (9.8%) | 2 (10.0%) | ||
| Non-Hispanic Hawaiian/Pacific | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | ||
| Non-Hispanic Native American | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | ||
| Non-Hispanic other race | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | ||
| Hispanic or Latino | 100 (27.1%) | 98 (27.6%) | 2 (14.3%) | 88 (27.0%) | 85 (27.8%) | 3 (15.0%) | ||
| Unknown | 1 (0.3%) | 1 (0.3%) | 0 (0.0%) | 1 (0.3%) | 1 (0.3%) | 0 (0.0%) | ||
| Area deprivation index (state rank) | 0.81 | 0.37 | ||||||
| 1–2 (Least deprivation) | 113 (30.6%) | 108 (30.4%) | 5 (35.7%) | 98 (30.1%) | 90 (29.4%) | 8 (40.0%) | ||
| 3–4 | 91 (24.7%) | 87 (24.5%) | 4 (28.6%) | 81 (24.8%) | 76 (24.8%) | 5 (25.0%) | ||
| 5–6 | 65 (17.6%) | 64 (18.0%) | 1 (7.1%) | 56 (17.2%) | 55 (18.0%) | 1 (5.0%) | ||
| 7–8 | 52 (14.1%) | 49 (13.8%) | 3 (21.4%) | 47 (14.4%) | 42 (13.7%) | 5 (25.0%) | ||
| 9–10 (most deprivation) | 44 (11.9%) | 43 (12.1%) | 1 (7.1%) | 41 (12.6%) | 40 (13.1%) | 1 (5.0%) | ||
| Missing | 4 (1.1%) | 4 (1.1%) | 0 (0.0%) | 3 (0.9%) | 3 (1.0%) | 0 (0.0%) | ||
| Financial class at the first COVID-19 diagnosis | 0.23 | 0.21 | ||||||
| Private insurance | 164 (44.4%) | 161 (45.4%) | 3 (21.4%) | 142 (43.6%) | 137 (44.8%) | 5 (25.0%) | ||
| Medicare/Medicaid | 201 (54.5%) | 190 (53.5%) | 11 (78.6%) | 182 (55.8%) | 167 (54.6%) | 15 (75.0%) | ||
| Self-pay | 1 (0.3%) | 1 (0.3%) | 0 (0.0%) | 1 (0.3%) | 1 (0.3%) | 0 (0.0%) | ||
| Other | 3 (0.8%) | 3 (0.8%) | 0 (0.0%) | 1 (0.3%) | 1 (0.3%) | 0 (0.0%) | ||
| Clinical history (at the first COVID-19 diagnosis) | ||||||||
| Body mass index | 0.59 | 0.68 | ||||||
| BMI ≤ 18.5 | 6 (1.6%) | 6 (1.7%) | 0 (0.0%) | 5 (1.5%) | 5 (1.6%) | 0 (0.0%) | ||
| BMI = 18.5–25 | 38 (10.3%) | 35 (9.9%) | 3 (21.4%) | 34 (10.4%) | 30 (9.8%) | 4 (20.0%) | ||
| BMI = 25–30 | 56 (15.2%) | 55 (15.5%) | 1 (7.1%) | 51 (15.6%) | 47 (15.4%) | 4 (20.0%) | ||
| BMI = 30–35 | 40 (10.8%) | 39 (11.0%) | 1 (7.1%) | 37 (11.3%) | 36 (11.8%) | 1 (5.0%) | ||
| BMI = 35–40 | 5 (1.4%) | 5 (1.4%) | 0 (0.0%) | 5 (1.5%) | 5 (1.6%) | 0 (0.0%) | ||
| BMI > 40 | 3 (0.8%) | 3 (0.8%) | 0 (0.0%) | 3 (0.9%) | 3 (1.0%) | 0 (0.0%) | ||
| Missing | 221 (59.9%) | 212 (59.7%) | 9 (64.3%) | 191 (58.6%) | 180 (58.8%) | 11 (55.0%) | ||
| Charlson comorbidity index components | ||||||||
| Asthma | 53 (14.4%) | 51 (14.4%) | 2 (14.3%) | 0.99 | 49 (15.0%) | 47 (15.4%) | 2 (10.0%) | 0.52 |
| COPD | 100 (27.1%) | 94 (26.5%) | 6 (42.9%) | 0.18 | 90 (27.6%) | 81 (26.5%) | 9 (45.0%) | 0.073 |
| Tuberculosis | 7 (1.9%) | 6 (1.7%) | 1 (7.1%) | 0.14 | 6 (1.8%) | 5 (1.6%) | 1 (5.0%) | 0.28 |
| Myocardial infarction | 87 (23.6%) | 82 (23.1%) | 5 (35.7%) | 0.28 | 79 (24.2%) | 70 (22.9%) | 9 (45.0%) | 0.025 |
| Congestive heart failure | 143 (38.8%) | 137 (38.6%) | 6 (42.9%) | 0.75 | 130 (39.9%) | 119 (38.9%) | 11 (55.0%) | 0.15 |
| Peripheral vascular disease | 222 (60.2%) | 216 (60.8%) | 6 (42.9%) | 0.18 | 194 (59.5%) | 183 (59.8%) | 11 (55.0%) | 0.67 |
| Cerebrovascular disease | 140 (37.9%) | 134 (37.7%) | 6 (42.9%) | 0.7 | 124 (38.0%) | 114 (37.3%) | 10 (50.0%) | 0.26 |
| Diabetes without complications | 34 (9.2%) | 34 (9.6%) | 0 (0.0%) | 0.22 | 27 (8.3%) | 26 (8.5%) | 1 (5.0%) | 0.58 |
| Diabetes with complications | 213 (57.7%) | 208 (58.6%) | 5 (35.7%) | 0.089 | 187 (57.4%) | 179 (58.5%) | 8 (40.0%) | 0.11 |
| Renal disease | 355 (96.2%) | 342 (96.3%) | 13 (92.9%) | 0.5 | 315 (96.6%) | 297 (97.1%) | 18 (90.0%) | 0.09 |
| Peptic ulcer disease | 35 (9.5%) | 33 (9.3%) | 2 (14.3%) | 0.53 | 30 (9.2%) | 27 (8.8%) | 3 (15.0%) | 0.35 |
| Mild liver disease | 118 (32.0%) | 115 (32.4%) | 3 (21.4%) | 0.39 | 109 (33.4%) | 104 (34.0%) | 5 (25.0%) | 0.41 |
| Moderate to severe liver disease | 62 (16.8%) | 57 (16.1%) | 5 (35.7%) | 0.054 | 50 (15.3%) | 43 (14.1%) | 7 (35.0%) | 0.012 |
| Dementia | 3 (0.8%) | 3 (0.8%) | 0 (0.0%) | 0.73 | 3 (0.9%) | 3 (1.0%) | 0 (0.0%) | 0.66 |
| Hemiplegia | 18 (4.9%) | 18 (5.1%) | 0 (0.0%) | 0.39 | 16 (4.9%) | 15 (4.9%) | 1 (5.0%) | 0.98 |
| Rheumatoid disease | 27 (7.3%) | 27 (7.6%) | 0 (0.0%) | 0.28 | 24 (7.4%) | 23 (7.5%) | 1 (5.0%) | 0.68 |
| Cancer | 61 (16.5%) | 59 (16.6%) | 2 (14.3%) | 0.82 | 52 (16.0%) | 50 (16.3%) | 2 (10.0%) | 0.45 |
| Metastatic cancer | 42 (11.4%) | 41 (11.5%) | 1 (7.1%) | 0.61 | 34 (10.4%) | 32 (10.5%) | 2 (10.0%) | 0.95 |
| HIV/AIDS | 4 (1.1%) | 4 (1.1%) | 0 (0.0%) | 0.69 | 4 (1.2%) | 4 (1.3%) | 0 (0.0%) | 0.61 |
| Transplant characteristics | ||||||||
| Transplanted organ | 0.36 | 0.036 | ||||||
| Kidney | 272 (73.7%) | 263 (74.1%) | 9 (64.3%) | 240 (73.6%) | 230 (75.2%) | 10 (50.0%) | ||
| Liver | 52 (14.1%) | 48 (13.5%) | 4 (28.6%) | 43 (13.2%) | 37 (12.1%) | 6 (30.0%) | ||
| Heart | 12 (3.3%) | 11 (3.1%) | 1 (7.1%) | 10 (3.1%) | 8 (2.6%) | 2 (10.0%) | ||
| Lung | 24 (6.5%) | 24 (6.8%) | 0 (0.0%) | 24 (7.4%) | 22 (7.2%) | 2 (10.0%) | ||
| Heart–lung | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | ||
| Pancreas | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | ||
| Kidney–pancreas | 9 (2.4%) | 9 (2.5%) | 0 (0.0%) | 9 (2.8%) | 9 (2.9%) | 0 (0.0%) | ||
| Other (includes islet) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | ||
| Donor type | 0.55 | 0.21 | ||||||
| Deceased donor (brain death) | 133 (36.0%) | 127 (35.8%) | 6 (42.9%) | 123 (37.7%) | 112 (36.6%) | 11 (55.0%) | ||
| Deceased donor (cardiac death) | 31 (8.4%) | 29 (8.2%) | 2 (14.3%) | 28 (8.6%) | 26 (8.5%) | 2 (10.0%) | ||
| Living donor | 205 (55.6%) | 199 (56.1%) | 6 (42.9%) | 175 (53.7%) | 168 (54.9%) | 7 (35.0%) | ||
| COVID-19 characteristics | ||||||||
| Date of the first recorded COVID-19 diagnosis (by local peak) | 0.8 | 0.052 | ||||||
| 1 February 2020–15 September 2020 | 6 (1.6%) | 5 (1.4%) | 1 (7.1%) | 6 (1.8%) | 4 (1.3%) | 2 (10.0%) | ||
| 16 September 2020–20 June 2021 | 59 (16.0%) | 57 (16.1%) | 2 (14.3%) | 59 (18.1%) | 53 (17.3%) | 6 (30.0%) | ||
| 21 June 2021–20 November 2021 | 55 (14.9%) | 53 (14.9%) | 2 (14.3%) | 55 (16.9%) | 52 (17.0%) | 3 (15.0%) | ||
| 21 November 2021–1 April 2022 | 53 (14.4%) | 50 (14.1%) | 3 (21.4%) | 52 (16.0%) | 48 (15.7%) | 4 (20.0%) | ||
| 2 April 2022–15 October 2022 | 61 (16.5%) | 60 (16.9%) | 1 (7.1%) | 61 (18.7%) | 60 (19.6%) | 1 (5.0%) | ||
| 16 October 2022–1 June 2023 | 60 (16.3%) | 57 (16.1%) | 3 (21.4%) | 60 (18.4%) | 57 (18.6%) | 3 (15.0%) | ||
| 2 June 2023–15 November 2023 | 33 (8.9%) | 32 (9.0%) | 1 (7.1%) | 33 (10.1%) | 32 (10.5%) | 1 (5.0%) | ||
| 16 November 2023–1 May 2024 | 38 (10.3%) | 37 (10.4%) | 1 (7.1%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | ||
| 2 May 2024–15 December 2024 | 4 (1.1%) | 4 (1.1%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | ||
| Status at the first recorded COVID-19 diagnostic encounter | ||||||||
| Hospitalized within 30 days | 149 (40.4%) | 143 (40.3%) | 6 (42.9%) | 0.85 | 135 (41.4%) | 125 (40.8%) | 10 (50.0%) | 0.42 |
| Intensive care admission within 30 days | 79 (21.4%) | 75 (21.1%) | 4 (28.6%) | 0.51 | 69 (21.2%) | 62 (20.3%) | 7 (35.0%) | 0.12 |
Differences across exposure groups compared using Fisher's exact tests (categorical variables) or Kruskal–Wallis tests (continuous variables).
Includes patients whose first recorded COVID-19 laboratory test positive was within 30 days +/− of transplant. Exposures: demographic and clinical variables abstracted from EMR at the first COVID-19 diagnostic encounter. Outcome: composite all-cause mortality or graft failure within 90 days or 1 year of transplant date. Patients who received transplants within 90 days (Outcome A) or 1 year (Outcome B) of the study end date and those lost to follow-up were excluded.
Legend: Kaplan–Meier analyses, the y-axis represents survivorship, the x-axis represents analysis, time zero was the date of transplant, and composite events were recorded as the date of death or graft failure; patients were right-censored at study end or date of loss to follow-up. CI, confidence interval.
Survival function at 90 days: 0.96, CI: 0.94–0.98.
Survival function at 365 days: 0.94, CI: 0.91–0.96.