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 D.; Ostrander, Darin; Steinke, Seema Mehta; Permpalung, Nitipong; Cochran, Willa; Makary, Martin A.; Garonzik-Wang, Jacqueline; Segev, Dorry L.; Massie, Allan B.

doi:10.1111/ajt.16431

Cited by 75 publications

(105 citation statements)

References 23 publications

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“…Mortality rates reported among SOT recipients with COVID-19 vary widely from 3% to over 30% depending on organ type, comorbid conditions, geographical location, COVID-19 treatment, and time of report during the pandemic [1,2]. Data are conflicting as to whether SOT recipients have higher risk of mortality compared with non-SOT recipients [2][3][4][5][6][7][8]. Furthermore, SOT recipients often have comorbidities, such as diabetes, chronic kidney disease, and cardiac disease, that have been associated with more severe cases of COVID-19 and an increased risk of mortality.…”

Section: Introductionmentioning

confidence: 99%

A Review of Treatment and Prevention of Coronavirus Disease 2019 among Solid Organ Transplant Recipients

Buehrle

Sutton

McCann

et al. 2021

Viruses

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Therapeutic management of solid organ transplant (SOT) recipients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), may challenge healthcare providers given a paucity of clinical data specific to this cohort. Herein, we summarize and review the studies that have formed the framework for current COVID-19 consensus management guidelines. Our review focuses on COVID-19 treatment options including monoclonal antibody products, antiviral agents such as remdesivir, and immunomodulatory agents such as corticosteroids, interleukin inhibitors, and kinase inhibitors. We highlight the presence or absence of clinical data of these therapeutics related to the SOT recipient with COVID-19. We also describe data surrounding COVID-19 vaccination of the SOT recipient. Understanding the extent and limitations of observational and clinical trial data for the prevention and treatment of COVID-19 specific to the SOT population is crucial for optimal management. Although minimal data exist on clinical outcomes among SOT recipients treated with varying COVID-19 therapeutics, reviewing these agents and the studies that have led to their inclusion or exclusion in clinical management of COVID-19 highlights the need for further studies of these therapeutics in SOT patients with COVID-19.

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Section: Introductionmentioning

confidence: 99%

A Review of Treatment and Prevention of Coronavirus Disease 2019 among Solid Organ Transplant Recipients

Buehrle

Sutton

McCann

et al. 2021

Viruses

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“…The numbers of pregnant women with heart disease were too small for the risk in this group to be estimated. Other studies of outcome of COVID-19 in solid organ transplant recipients and other individuals using immunosuppressants have been based only on patients admitted to hospital [11,12]. Such studies cannot assess the risks to immunosuppressed individuals in the population.…”

Section: Discussionmentioning

confidence: 99%

Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study

McAllister

Caldwell

Gribben

et al. 2021

Preprint

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ObjectivesTo investigate:(1) the risk of severe COVID-19 in those eligible for shielding, and (2) the relation of severe COVID-19 to transmission-related factors in those in shielding and the general population.DesignMatched case-control study (REACT-SCOT).SettingPopulation of Scotland from 1 March 2020 to 28 January 2021.ParticipantsAll 160307 diagnosed cases of COVID-19 and 1564782 controls matched for age, sex and primary care practice, linked with all 204913 individuals identified as eligible for shielding by Public Health Scotland.Main outcome measureSevere COVID-19, defined as cases that entered critical care or were fatal.ResultsWith those without risk conditions as reference category, the univariate rate ratio for severe COVID-19 was 5.3 (95% CI 5.0 to 5.7, p=4 × 10−527) in those with moderate risk conditions and 7.6 (95% CI 7.1 to 8.3, p=1 × 10−527) in those eligible for shielding. The highest rate was in solid organ transplant recipients: rate ratio 13.6 (95% CI 9.6 to 19.2, p=8 × 10−50). In both the shielded and the general population, the risk of severe COVID-19 increased with the number of adults but decreased with the number of school-age children in the household. Severe COVID-19 was strongly associated with recent exposure to hospital (defined as 5 to 14 days before presentation date): rate ratio 12.6 (95% CI 11.7 to 13.6, p=2 × 10−989) overall. In a case-crossover analysis with less recent exposure only (15 to 24 days before first testing positive) as reference category, the rate ratio associated with recent exposure only was 6.3 (95% CI 3.6 to 11.1, p=2 × 10−10). Among those eligible for shielding, the population attributable risk fraction (PARF) of severe cases for recent exposure to hospital was 36%. In the general population the PARF for recent exposure to hospital peaked at 46% in May 2020 and again at 64% in December 2020.ConclusionsThe effectiveness of shielding vulnerable individuals was limited by the inability to control transmission in hospital and from other adults in the household. For solid organ transplant recipients, in whom the efficacy of vaccines is uncertain, these results support a policy of offering vaccination to household contacts. Mitigating the impact of the epidemic requires control of nosocomial transmission.SummaryWhat is already known on this topic?Individuals designated as “clinically extremely vulnerable” – about 3% of the population – have been advised to shield themselves during the COVID-19 epidemicThe effectiveness of this shielding programme has not been evaluated.What this study addsHospital-acquired infection has made a substantial contribution to the burden of COVID-19 in the population, accounting for more than half of severe cases in early December 2020.For vulnerable individuals to be shielded, the risk of hospital-acquired infection must be reduced and support must be provided for other adults in the household to co-isolate with the vulnerable individual.Solid organ transplant recipients are at the highest risk; vaccination of household contacts should be considered for this group.

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“…Another study found that despite higher risk profile, solid organ transplant recipients improved rapidly and their disease severity declined at a faster rate than others. 11 The pathogenesis of COVID-19 is thought to comprise an interplay between direct virus induced injury and the host response, with evidence suggesting that a dysregulated and hyperintense immune response mediates more severe disease. 12 As we know that immunosuppressive agents modulate different aspects of the host immune response, the severity of COVID-19 disease could potentially be affected by the type, combinations, and dosages of immunosuppression being used.…”

Section: Discussionmentioning

confidence: 99%

Single Center Analysis of Incidence and Outcome of COVID-19 Infection in Solid Organ Transplant Recipients

Rana¹,

Qayyum²,

Latif³

et al. 2021

PJMHS

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Aim: To determine overall mortality, outcome and mortality of COVID 19 infection in solid organ transplant pts. Study design: Retrospective study. Place and duration of study: Department of Medicine, Bahria International Hospital, Lahore, Pakistan15thApril 2020 to 31stDecember 2020. Methodology: Twenty-three patients 18 out of which were kidney transplant recipients while 5 were liver transplant recipients. All the solid organ transplant patients who were admitted with Sars CoV2 (Corona virus) infection were recorded. Their charts were reviewed regarding clinical course, management, and outcome of COVID-19 infection in recipients of solid organ (liver and kidney) transplant. Results: Mean age was 44.8±10.9 years. Median time lapsed from transplant surgery to admission was 2.88 years (interquartile range 2.25, 7.33). Median hospital stay was 15 days (interquartile range 13, 28). All 23 patients were admitted and managed, with 17 (73.91%) admitted in ICU. Over half of the cases (58.2%) presented with raised serum creatinine due to acute kidney injury. 80% received azithromycin, Tocilizumab and 50% received Remdesivir.Antimetabolites with or without calcineurin inhibitors were held or reduced. A total of 5 patients had died while the others 18 patients (78.26%) were discharged home. Conclusion: There is a theoretical high risk of getting Sars CoV-2 infection in post-transplant patients but we did not find any increase in overall mortality in solid organ transplant recipients receiving immunosuppressive therapy who acquired Sars CoV2 infection as compared with mortality in the general patients with SARS-CoV-2. We had favorable outcome in solid organ transplant COVID 19 patients in our center. Keywords: Incidence, Outcome, COVID-19, Infection

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Inpatient COVID-19 outcomes in solid organ transplant recipients compared to non-solid organ transplant patients: A retrospective cohort

Cited by 75 publications

References 23 publications

A Review of Treatment and Prevention of Coronavirus Disease 2019 among Solid Organ Transplant Recipients

A Review of Treatment and Prevention of Coronavirus Disease 2019 among Solid Organ Transplant Recipients

Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study

Single Center Analysis of Incidence and Outcome of COVID-19 Infection in Solid Organ Transplant Recipients

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