COVID-19 in solid organ transplant: A multi-center cohort study

Olivia S Kates; Brandy M Haydel; Sander S Florman; Meenakshi M Rana; Zohra S Chaudhry; Mayur S Ramesh; Kassem Safa; Camille Nelson Kotton; Emily A Blumberg; Behdad D Besharatian; Sajal D Tanna; Michael G Ison; Maricar Malinis; Marwan M Azar; Robert M Rakita; Jose A Morillas; Aneela Majeed; Afrah S Sait; Mario Spaggiari; Vagish Hemmige; Sapna A Mehta; Henry Neumann; Abbasali Badami; Jason D Goldman; Anuradha Lala; Marion Hemmersbach-Miller; Margaret E McCort; Valida Bajrovic; Carlos Ortiz-Bautista; Rachel Friedman-Moraco; Sameep Sehgal; Erika D Lease; Cynthia E Fisher; Ajit P Limaye; UW COVID-19 SOT Study Team

doi:10.1093/cid/ciaa1097

. 2020 Aug 7:ciaa1097. doi: 10.1093/cid/ciaa1097

COVID-19 in solid organ transplant: A multi-center cohort study

Olivia S Kates ¹, Brandy M Haydel ², Sander S Florman ², Meenakshi M Rana ³, Zohra S Chaudhry ⁴, Mayur S Ramesh ⁴, Kassem Safa ⁵, Camille Nelson Kotton ⁶, Emily A Blumberg ⁷, Behdad D Besharatian ⁷, Sajal D Tanna ⁸, Michael G Ison ^8,⁹, Maricar Malinis ¹⁰, Marwan M Azar ¹⁰, Robert M Rakita ¹, Jose A Morillas ¹¹, Aneela Majeed ¹¹, Afrah S Sait ¹², Mario Spaggiari ¹³, Vagish Hemmige ¹⁴, Sapna A Mehta ¹⁵, Henry Neumann ¹⁵, Abbasali Badami ¹⁶, Jason D Goldman ^1,¹⁷, Anuradha Lala ¹⁸, Marion Hemmersbach-Miller ¹⁹, Margaret E McCort ¹⁴, Valida Bajrovic ²⁰, Carlos Ortiz-Bautista ²¹, Rachel Friedman-Moraco ²², Sameep Sehgal ²³, Erika D Lease ²⁴, Cynthia E Fisher ^1,^#, Ajit P Limaye ^1,^#,^✉; UW COVID-19 SOT Study Team

¹ Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA

² Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

³ Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

⁴ Transplantation Infectious Diseases and Inmunotherapy, Henry Ford Health System, Detroit, MI, USA

⁵ Transplant Center and Division of Nephrology, Massachusetts General Hospital, Boston, MA, USA

⁶ Transplant Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA

⁷ Department of Medicine, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA

⁸ Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

⁹ Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

¹⁰ Section of Infectious Diseases, Department of Internal Medicine, Yale-New School of Medicine, New Haven, CT, USA

¹¹ Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA

¹² Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA

¹³ Division of Transplantation, University of Illinois at Chicago, Chicago, IL, USA

¹⁴ Montefiore Medical Center, Bronx, NY, USA

¹⁵ NYU Langone Transplant Institute, New York, NY, USA

¹⁶ SUNY Downstate Health Sciences University, Brooklyn, NY, USA

¹⁷ Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, WA, USA

¹⁸ Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

¹⁹ Section of Infectious Diseases Baylor College of Medicine, Houston, TX, USA

²⁰ Division of Infectious Disease, Department of Medicine, University of Colorado, Aurora, CO, USA

²¹ Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain

²² Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA

²³ Department of Thoracic Medicine And Surgery, Temple University, Philadelphia, PA, USA

²⁴ Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA

^✉

Correspondence: Ajit P. Limaye, M.D. Professor of Medicine, University of Washington, 1959 N.E. Pacific St. Seattle, WA 98195-6174, TEL: +1 206 598 1041, limaye@uw.edu

Cynthia E Fisher MD and Ajit P Limaye MD contributed equally to this manuscript.

PMCID: PMC7454362 PMID: 32766815

Abstract

Background

The COVID-19 pandemic has led to significant reductions in transplantation, motivated in part by concerns of disproportionately more severe disease among solid organ transplant (SOT) recipients. However, clinical features, outcomes, and predictors of mortality in SOT recipients are not well-described.

Methods

We performed a multi-center cohort study of SOT recipients with laboratory-confirmed COVID-19. Data were collected using standardized intake and 28-day follow-up electronic case report forms. Multivariable logistic regression was used to identify risk factors for the primary endpoint, 28-day mortality, among hospitalized patients.

Results

Four hundred eighty-two SOT recipients from >50 transplant centers were included: 318 (66%) kidney or kidney/pancreas, 73 (15.1%) liver, 57 (11.8%) heart, and 30 (6.2%) lung. Median age was 58 (IQR 46-57), median time post-transplant was 5 years (IQR 2-10), 61% were male, and 92% had ≥1 underlying comorbidity. Among those hospitalized (376 [78%]), 117 (31%) required mechanical ventilation, and 77 (20.5%) died by 28 days after diagnosis. Specific underlying comorbidities (age >65 [aOR 3.0, 95%CI 1.7-5.5, p<0.001], congestive heart failure [aOR 3.2, 95%CI 1.4-7.0, p=0.004], chronic lung disease [aOR 2.5, 95%CI 1.2-5.2, p=0.018], obesity [aOR 1.9, 95% CI 1.0-3.4, p=0.039]) and presenting findings (lymphopenia [aOR 1.9, 95%CI 1.1-3.5, p=0.033], abnormal chest imaging [aOR 2.9, 95%CI 1.1-7.5, p=0.027]) were independently associated with mortality. Multiple measures of immunosuppression intensity were not associated with mortality.

Conclusions

Mortality among SOT recipients hospitalized for COVID-19 was 20.5%. Age and underlying comorbidities rather than immunosuppression intensity-related measures were major drivers of mortality.

Keywords: COVID-19, SARS-CoV-2, coronavirus, transplantation, solid organ transplantation

PERMALINK

COVID-19 in solid organ transplant: A multi-center cohort study

Olivia S Kates, MD

Brandy M Haydel, CCRC

Sander S Florman, MD

Meenakshi M Rana, MD

Zohra S Chaudhry, MD

Mayur S Ramesh, MD

Kassem Safa, MD

Camille Nelson Kotton, MD

Emily A Blumberg, MD

Behdad D Besharatian, MD

Sajal D Tanna, MD

Michael G Ison, MD

Maricar Malinis, MD

Marwan M Azar, MD

Robert M Rakita, MD

Jose A Morillas, MD

Aneela Majeed, MD

Afrah S Sait, MD

Mario Spaggiari, MD

Vagish Hemmige, MD

Sapna A Mehta, MD

Henry Neumann, MD

Abbasali Badami, MD

Jason D Goldman, MD, MPH

Anuradha Lala, MD

Marion Hemmersbach-Miller, MD, PhD

Margaret E McCort, MD

Valida Bajrovic, MD

Carlos Ortiz-Bautista, MD

Rachel Friedman-Moraco, MD

Sameep Sehgal, MD

Erika D Lease, MD

Cynthia E Fisher, MD, MPH

Ajit P Limaye, MD

Abstract

Background

Methods

Results

Conclusions

ACTIONS

PERMALINK

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