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The outcome of transplant recipients is variable depending on the study population, vaccination status and COVID-19 variants. Our aim was to study the impact of Omicron subvariants on the mortality of transplant recipients. We reviewed the results of SARS-CoV-2 whole genome sequence of random isolates collected from 29 December 2021 until 17 May 2022 in King Faisal Specialist Hospital and Research center, Jeddah (KFSHRC-J), Saudi Arabia performed as hospital genomic surveillance program for COVID-19 variants. We included 25 transplant patients infected with confirmed Omicron variants.17 (68%) and 8 (32%) patients had Omicron BA.1 and BA.2, respectively. 12 (68%) patients had renal transplants. Only 36% of patients received three doses of COVID-19 vaccines. 23 (92%) patients required hospitalization. 20 (80%) patients survived and 6 (25%) required intensive care unit (ICU) admission. Among ICU patients, 66.7% were more than 50 years, 50% had two to three comorbidities and 5 out of 6 (83%) died. The mortality of transplant patients infected with Omicron variants in our cohort was higher than other centers as a limited number of patients received booster vaccines. Optimizing booster vaccination is the most efficient method to improve the mortality of COVID-19 in transplant recipients recognizing the inefficacy of monoclonal antibodies in the presence of SARS-CoV-2 emerging variants. We did not show a difference in mortality in transplant patients infected with Omicron BA.1 and BA.2 knowing the limitation of our sample size.

Background COVID-19 vaccination effectively decreased hospitalization and mortality during the surge of infections with the SARS-CoV-2 Omicron variant. However, patients infected with the Omicron variant who did not receive a third COVID-19 vaccine booster often required critical care unit (CCU) admission. The CCU bed utilization of COVID-19 posed a worldwide burden. The decision to stop isolation of patients with COVID-19 in CCUs is challenging, given the variable viral shedding in heterogeneous patient populations. Rapid antigen detection tests (RADTs) have been used in communities to determine patients’ infectiousness and need for quarantine. However, the use of RADTs in the de-isolation of CCU patients had not been studied. Methods Serial RADTs, RT-PCR and viral culturing were performed in a case series of three critically ill patients infected with Omicron variants. Results The duration of infectious viral shedding was 13–46 days post symptom onset (PSO). Concordant negative results were observed between RADTs and viral cultures on D32 PSO in case 1; D13 and D15 PSO in case 2; and D46 and D48 PSO in case 3. In addition, concordant positive results were found between RADTs and viral cultures on D35 PSO in case 2. Significant agreement was observed between RADT and viral culture findings (kappa statistic = 1.0 and p-value = 0.014). Conclusion Given their high positive predictive value with respect to positive viral cultures, RADTs may be a promising and practical tool for ending isolation of patients with COVID-19 and decreasing the burden of CCU bed utilization. Future studies are necessary to confirm our findings.