Incidence and Outcomes of COVID-19 in Kidney and Liver Transplant Recipients With HIV: Report From the National HOPE in Action Consortium.

Mehta, Sapna A; Rana, Meenakshi M; Motter, Jennifer D; Small, Catherine B; Pereira, Marcus R; Stosor, Valentina; Elias, Nahel; Haydel, Brandy; Florman, Sander; Odim, Jonah; Morsheimer, Megan; Robien, Mark; Massie, Allan B; Brown, Diane; Boyarsky, Brian; Garonzik Wang, Jacqueline; Tobian, Aaron A R; Werbel, William A; Segev, Dorry L; Durand, Christine M

BACKGROUND Transplant recipients with HIV may have worse outcomes with coronavirus disease 2019 (COVID-19) due to impaired T-cell function coupled with immunosuppressive drugs. Alternatively, immunosuppression might reduce inflammatory complications and/or antiretrovirals could be protective. METHODS Prospective reporting of all cases of SARS-CoV-2 infection was required within the HOPE in Action Multicenter Consortium, a cohort of kidney and liver transplant recipients with HIV who have received organs from donors with and without HIV at 32 transplant centers in the United States. RESULTS Between 3/20/2020-9/25/2020, there were 11 COVID-19 cases among 291 kidney and liver recipients with HIV (4%). In those with COVID-19, median age was 59 years, 10 were male, 8 were kidney recipients, and 5 had donors with HIV. A higher proportion of recipients with COVID-19 compared to the overall HOPE in Action cohort were Hispanic (55% vs 12%) and received transplants in New York City (73% vs 34%, p< 0.05). Most (10/11, 91%) were hospitalized. High-level oxygen support was required in 7 and intensive care in 5; 1 participant opted for palliative care instead of transfer to the intensive care unit. HIV RNA was undetectable in all. Median absolute lymphocyte count was 0.3 x 10 cells/μL. Median CD4 pre-COVID-19 was 298 cells/μL, declining to <200 cells/ul in 6/7 with measurements on admission. Treatment included high-dose steroids (n=6), tocilizumab (n=3), remdesivir (n=2), and convalescent plasma (n=2). Four patients (36%) died. CONCLUSION Within a national prospective cohort of kidney and liver transplant recipients with HIV, we report high mortality from COVID-19.