Outcome of Transplant Recipients Infected with Omicron BA.1 and BA.2: A Single-Center Retrospective Study in Saudi Arabia

Abstract

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.

A review of the clinical characteristics and management of immunosuppressed patients living with HIV or solid organ transplants infected with SARS-CoV-2 omicron variants

“…Mortality rates for hospitalized transplant recipients infected with omicron variants vary: 20% at a tertiary health center in Jeddah, Saudi Arabia ( 67 ), 4% in a US study ( 62 ), and 16% in Spain ( 65 ). Three doses of vaccine do not appear to reduce the mortality rate in transplant recipient patients ( 64 ), but early use of SARS-CoV-2 monoclonal antibodies (in addition to vaccination) is associated with preventing severe disease progression and oxygen demand ( 68 ).…”

“…There are currently insufficient data showing that omicron variants produce a different spectrum of disease. Abeer et al ( 67 ) studied omicron patients (confirmed by whole genome sequencing) and did not find a specific omicron variant associated with poor prognosis. A recent study from South Africa showed that omicron B.A 1, 2, 4, and 5 were associated with decreased vaccine efficacy and an increase in hospitalization rates 4 months after booster vaccination.…”