COVID-19 in Solid Organ Transplantation: Disease Severity and Clinical Update

Arya, Akanksha; Li, Michael; Aburjania, Nana; Singh, Pooja; Royer, Tricia; Moss, Sean; Belden, Katherine

Background Solid organ transplant (SOT) recipients are a complex, immunocompromised population in whom greater COVID-19 mortality has been reported as compared to the general population. Methods We examined a retrospective cohort of 58 SOT recipients with first-wave COVID-19, comparing patients with severe and non-severe illness. Additionally, SOT patients are compared to general first-wave COVID-19 patients. Results Organs transplanted included 38 kidneys, 8 livers, 5 hearts, 3 pancreas. Average SOT patient age was 57.4 years with 62% male, 46.6% African American, 36.2% white. Comorbidities included hypertension (86%), chronic kidney disease (86%), diabetes mellitus (50%), coronary artery disease (26%), COPD (14%). Twenty patients (34.5%) had severe COVID-19 and 38 (65.5%) non-severe disease. Severe disease was more common in older SOT patients with comorbidities and associated with cough, dyspnea, pneumonia, C-reactive protein > 10 mg/L, platelet count < 150/mcL. Gender, race, BMI, time from transplant, baseline immunosuppression and diagnosis month did not differ between those with severe vs non-severe COVID-19. Seventy percent of SOT patients were hospitalized vs 27.2% of general COVID-19 patients and SOT inpatients had a higher mechanical ventilation rate. While trending towards longer length of stay, higher ICU admission and greater inpatient mortality (19.5% vs 14.8%), these differences were not significant. Conclusions SARS-CoV-2 has greatly impacted SOT recipients. One-third of our SOT patients seen during the first wave had severe illness with associated standard risk factors for poor outcome. Compared to general first wave patients, more SOT recipients were hospitalized, although inpatient COVID-19 mortality did not significantly differ.