Inpatient COVID-19 Outcomes in Solid Organ Transplant Recipients Compared to Non-Solid Organ Transplant Patients: A Retrospective Cohort.

Avery, Robin K; Chiang, Teresa Po-Yu; Marr, Kieren A; Brennan, Daniel C; Sait, Afrah S; Garibaldi, Brian T; Shah, Pali; Ostrander, Darin; Mehta Steinke, Seema; Permpalung, Nitipong; Cochran, Willa; Makary, Martin A; Garonzik-Wang, Jacqueline; Segev, Dorry L; Massie, Allan B

Immunosuppression and comorbidities might place solid organ transplant (SOT) recipients at higher risk from COVID-19, as suggested by recent case series. We compared 45 SOT vs 2427 non-SOT patients who were admitted with COVID-19 to our health-care system (3/1/20-8/21/20), evaluating hospital length-of-stay and inpatient mortality using competing risks regression. We compared trajectories of WHO COVID-19 severity scale using mixed-effects ordinal logistic regression, adjusting for severity score at admission. SOT and non-SOT patients had comparable age, sex, and race, but SOT recipients were more likely to have diabetes (60% vs. 34%, p < 0.001), hypertension (69% vs. 44%, p = 0.001), HIV (7% vs 1.4%, p = 0.024), and peripheral vascular disorders (19% vs. 8%, p = 0.018). There were no statistically significant differences between SOT and non-SOT in maximum illness severity score (p = 0.13), length-of-stay (sHR=0.9 1.11.4 , p = 0.5), or mortality (sHR:0.1 0.41.6 , p = 0.19), although the severity score on admission was slightly lower for SOT (median (IQR) 3 (3, 4)) than for non-SOT (median (IQR) 4 (3-4)), (p = 0.042) Despite a higher risk profile, SOT recipients had a faster decline in disease severity over time (OR=0.76 0.810.86 , p < 0.001) compared with non-SOT patients. These findings have implications for transplant decision-making during the COVID-19 pandemic, and insights about the impact of SARS-CoV-2 on immunosuppressed patients.