SARS‐CoV‐2 infection and early mortality of wait‐listed and solid organ transplant recipients in England: a national cohort study

Ravanan, Rommel; Callaghan, Chris J.; Mumford, Lisa; Ushiro‐Lumb, Ines; Thorburn, Douglas; Casey, John; Friend, Peter; Parameshwar, Jayan; Currie, Ian; Burnapp, Lisa; Baker, Richard; Dudley, Jan; Oniscu, Gabriel C.; Berman, Marius; Asher, John; Harvey, Dan; Manara, Alex; Manas, Derek; Gardiner, Dale; Forsythe, John L.R.

Patients wait‐listed for and recipients of solid organ transplants (SOT) are perceived to have a higher risk of contracting SARS‐CoV‐2 and death; however, definitive epidemiological evidence is lacking. In a comprehensive national cohort study enabled by linkage of the UK transplant registry and Public Health England and NHS Digital Tracing services we examined the incidence of laboratory confirmed SARS‐CoV‐2 infection and subsequent mortality in patients on the active waiting list for a deceased donor SOT and recipients with a functioning SOT as of 1st February 2020 with follow up to 20th May 20202. Univariate and multivariable techniques were used to compare differences between groups and to control for case‐mix. 197 (3·8%) of the 5,184 wait‐listed patients and 597 (1·3%) of the 46,789 SOT recipients tested positive for SARS‐CoV‐2. Mortality after testing positive for SARS‐CoV‐2 was 10·2% (20/197) for wait‐listed patients and 25·8% (154/597) for SOT recipients. Increasing recipient age was the only variable independently associated with death after positive SARS‐CoV‐2 test. Of the 1004 transplants performed in 2020, 41 (4·1%) recipients have tested positive for SARS‐CoV‐2 with 8 (0·8%) deaths reported by 20th May. These data provide evidence to support decisions on the risks and benefits of SOT during the COVID‐19 pandemic.