SARS-CoV-2 infection and early mortality of waitlisted and solid organ transplant recipients in England: A national cohort study

Abstract

Patients waitlisted for and recipients of solid organ transplants (SOT) are perceived to have a higher risk of contracting severe acute respiratory syndrome coronavirus 2 (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 February 1, 2020 with follow‐up to May 20, 2020. Univariate and multivariable techniques were used to compare differences between groups and to control for case‐mix. One hundred ninety‐seven (3.8%) of the 5184 waitlisted 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 waitlisted 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 May 20. These data provide evidence to support decisions on the risks and benefits of SOT during the coronavirus disease 2019 pandemic.

SARS-CoV-2 in Kidney Transplant and Waitlisted Patients During the First Peak: The Welsh Experience

“…There is a low incidence of SARS-CoV-2 symptomatic infections among the transplant patients (0.87%) compared to an estimated 0.47% of the national population in Wales [ 8 ] and 1.4% among English patients with a functioning kidney transplant [ 9 ]. Given the testing policy in the United Kingdom, in the early months of the outbreak, the real numbers of the general population infected with SARS-CoV-2 are likely to be higher.…”

Impact of COVID-19 Pandemic on Pediatrics and Pediatric Transplantation Programs

“…Although pediatric SOT recipients are at increased risk for severe manifestations of common infections (55), case reports and case series of SARS-CoV-2 infection in pediatric SOT emerging thus far suggest pediatric SOT recipients are at similar risk and present with a similar spectrum of infection as other children (19,(56)(57)(58)(59); however data are significantly limited and caution is still recommended. For example, an evaluation of the UK Transplant Registry linked with the National Health Service Digital Tracing Services identified only three cases of SARS-CoV-2 among 1,703 pediatric SOT recipients (0.5%) and no deaths occurred during a 4-month period during the height of the first wave of the pandemic in the UK (60). Delineation of risk for individual SOT recipients is proposed based on host factors such as time from transplant, maintenance immunosuppressive regimen, recent augmentation of immunosuppression and developmental capability of participating in infection prevention strategies to reduce risk, such as social distancing and mask wearing.…”

Renal transplantation during the SARS‐CoV‐2 pandemic in the UK: Experience from a large‐volume center

“…On the other hand, there is significant concern about patients undergoing hemodialysis as these patients may be particularly vulnerable to both SARS‐CoV‐2 infection and severe sequelae 16 . Recently it was reported that 3.2% of patients on the solid organ transplant waiting list were affected by SARS‐CoV‐2 with an associated mortality of 10.2% 17 . In addition, there is a moratorium on organ donation from SARS‐CoV‐2 positive patients in the UK, which combined with a reduced national Intensive Care Unit (ICU) capacity nationally, may have a deleterious impact on donor numbers 18,19 …”