Incidence and outcome of SARS-CoV-2 infection on solid organ transplantation recipients: A nationwide population-based study

Abstract

Since February 21 2020, when the Italian National Institute of Health (Istituto Superiore di Sanità–ISS) reported the first autochthonous case of infection, a dedicated surveillance system for SARS‐CoV‐2‐positive (COVID+) cases has been created in Italy. These data were cross‐referenced with those inside the Information Transplant System in order to assess the cumulative incidence (CI) and the outcome of SARS‐COV‐2 infection in solid organ transplant recipients (SOTRs) who are assumed to be most at risk. We compared our results with those of COVID+ nontransplanted patients (Non‐SOTRs) with follow‐up through September 30, 2020. The CI of SARS‐CoV‐2 infection in SOTRs was 1.02%, higher than in COVID+ Non‐SOTRs (0.4%, p < .05) with a greater risk in the Lombardy region (2.89%). The CI by type of organ transplant was higher for heart (CI 1.57%, incidence rate ratio [IRR] 1.36) and lower for liver (CI 0.63%, IRR 0.54). The 60‐day CI of mortality was 30.6%, twice as much that of COVID+ Non‐SOTRs (15.4%) with a 60‐day gender and age adjusted odds ratio (adjusted‐OR) of 3.83 for COVID+ SOTRs (95% confidence interval [3.03–4.85]). The lowest 60‐day adjusted‐OR was observed in liver SOTRs (OR 0.46, 95% confidence interval [0.25–0.86]). More detailed studies on disease management and evolution will be necessary in these patients at greater risk of COVID‐19.

Impact of COVID-19 on the outcomes of gastrointestinal surgery

“…The nationwide study from the Italian registry reported that the cumulative incidence of COVID infection in SOT recipients was 1.02%, which was significantly higher than the non-transplant patients (0.4%) (p < 0.05) [51]. Among 450 SOT recipients with SAR-CoV-2 infection, 89 (19.8%) were LT recipients).…”

“…Out of 450 patients, 123 patients died during the follow-up period. The 30-day and 60-day mortality rates were lower in LT recipients compared to heart and kidney recipients (Table 3) [51].…”

Implications of COVID-19 for patients with pre-existing digestive diseases: an update

“…A nationwide population study in Italy found that the cumulative incidence of SARS-CoV-2 infection was higher in transplant recipients than in patients who had not had a transplant. 6 When stratified by type of organ transplant, the cumulative incidence was higher for heart transplants and lower for liver transplants versus kidney transplants. 6 However, more organ transplant recipients had two or three comorbidities than did the control population.…”

“…6 When stratified by type of organ transplant, the cumulative incidence was higher for heart transplants and lower for liver transplants versus kidney transplants. 6 However, more organ transplant recipients had two or three comorbidities than did the control population. 6 An analysis of 151 liver transplant recipients with SARS-CoV-2 infection in the COVID-Hep and SECURE-Cirrhosis registries showed that liver transplantation was not independently associated with death, whereas known risk factors, such as increased age and presence of comorbidities were.…”

“…6 However, more organ transplant recipients had two or three comorbidities than did the control population. 6 An analysis of 151 liver transplant recipients with SARS-CoV-2 infection in the COVID-Hep and SECURE-Cirrhosis registries showed that liver transplantation was not independently associated with death, whereas known risk factors, such as increased age and presence of comorbidities were. 7 For liver transplant recipients, most societies, such as the American Association for the Study of Liver Diseases and European Association for the Study of the Liver, advise against reducing immunosuppressive therapy to prevent SARS-CoV-2 infection.…”