COVID‐19 in solid organ transplant recipients: Initial report from the US epicenter

Pereira, Marcus R.; Mohan, Sumit; Cohen, David J.; Husain, Syed A.; Dube, Geoffrey K.; Ratner, Lloyd E.; Arcasoy, Selim; Aversa, Meghan M.; Benvenuto, Luke J.; Dadhania, Darshana M.; Kapur, Sandip; Dove, Lorna M.; Brown, Robert S.; Rosenblatt, Russell E.; Samstein, Benjamin; Uriel, Nir; Farr, Maryjane A.; Satlin, Michael; Small, Catherine B.; Walsh, Thomas J.; Kodiyanplakkal, Rosy P.; Miko, Benjamin A.; Aaron, Justin G.; Tsapepas, Demetra S.; Emond, Jean C.; Verna, Elizabeth C.

Solid organ transplant recipients may be at a high risk for SARS‐CoV‐2 infection and poor associated outcomes. We herein report our initial experience with solid organ transplant recipients with SARS‐CoV‐2 infection at two centers during the first 3 weeks of the outbreak in New York City. Baseline characteristics, clinical presentation, antiviral and immunosuppressive management were compared between patients with mild/moderate and severe disease (defined as ICU admission, intubation or death). Ninety patients were analyzed with a median age of 57 years. Forty‐six were kidney recipients, 17 lung, 13 liver, 9 heart, and 5 dual‐organ transplants. The most common presenting symptoms were fever (70%), cough (59%), and dyspnea (43%). Twenty‐two (24%) had mild, 41 (46%) moderate, and 27 (30%) severe disease. Among the 68 hospitalized patients, 12% required non‐rebreather and 35% required intubation. 91% received hydroxychloroquine, 66% azithromycin, 3% remdesivir, 21% tocilizumab, and 24% bolus steroids. Sixteen patients died (18% overall, 24% of hospitalized, 52% of ICU) and 37 (54%) were discharged. In this initial cohort, transplant recipients with COVID‐19 appear to have more severe outcomes, although testing limitations likely led to undercounting of mild/asymptomatic cases. As this outbreak unfolds, COVID‐19 has the potential to severely impact solid organ transplant recipients.