Olivia S Kates1, Brandy M Haydel2, Sander S Florman2, Meenakshi M Rana3, Zohra S Chaudhry4, Mayur S Ramesh4, Kassem Safa5, Camille Nelson Kotton6, Emily A Blumberg7, Behdad D Besharatian7, Sajal D Tanna8, Michael G Ison8,9, Maricar Malinis10, Marwan M Azar10, Robert M Rakita1, Jose A Morilla11, Aneela Majeed11, Afrah S Sait12, Mario Spaggiari13, Vagish Hemmige14, Sapna A Mehta15, Henry Neumann15, Abbasali Badami16, Jason D Goldman1,17, Anuradha Lala18, Marion Hemmersbach-Miller19, Margaret E McCort14, Valida Bajrovic20, Carlos Ortiz-Bautista21, Rachel Friedman-Moraco22, Sameep Sehgal23, Erika D Lease24, Cynthia E Fisher1, Ajit P Limaye1. 1. Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA. 2. Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 3. Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 4. Transplantation Infectious Diseases and Inmunotherapy, Henry Ford Health System, Detroit, Michigan, USA. 5. Transplant Center and Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA. 6. Transplant Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA. 7. Department of Medicine, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania, USA. 8. Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. 9. Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. 10. Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA. 11. Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA. 12. Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. 13. Division of Transplantation, University of Illinois at Chicago, Chicago, Illinois, USA. 14. Montefiore Medical Center, Bronx, New York, USA. 15. NYU Langone Transplant Institute, New York, New York, USA. 16. SUNY Downstate Health Sciences University, Brooklyn, New York, USA. 17. Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, Washington, USA. 18. Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 19. Section of Infectious Diseases Baylor College of Medicine, Houston, Texas, USA. 20. Division of Infectious Disease, Department of Medicine, University of Colorado, Aurora, Colorado, USA. 21. Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain. 22. Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA. 23. Department of Thoracic Medicine And Surgery, Temple University, Philadelphia, Pennsylvania, USA. 24. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA.
Abstract
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to significant reductions in transplantation, motivated in part by concerns of disproportionately more severe disease among solid organ transplant (SOT) recipients. However, clinical features, outcomes, and predictors of mortality in SOT recipients are not well described. METHODS: We performed a multicenter cohort study of SOT recipients with laboratory-confirmed COVID-19. Data were collected using standardized intake and 28-day follow-up electronic case report forms. Multivariable logistic regression was used to identify risk factors for the primary endpoint, 28-day mortality, among hospitalized patients. RESULTS: Four hundred eighty-two SOT recipients from >50 transplant centers were included: 318 (66%) kidney or kidney/pancreas, 73 (15.1%) liver, 57 (11.8%) heart, and 30 (6.2%) lung. Median age was 58 (interquartile range [IQR] 46-57), median time post-transplant was 5 years (IQR 2-10), 61% were male, and 92% had ≥1 underlying comorbidity. Among those hospitalized (376 [78%]), 117 (31%) required mechanical ventilation, and 77 (20.5%) died by 28 days after diagnosis. Specific underlying comorbidities (age >65 [adjusted odds ratio [aOR] 3.0, 95% confidence interval [CI] 1.7-5.5, P < .001], congestive heart failure [aOR 3.2, 95% CI 1.4-7.0, P = .004], chronic lung disease [aOR 2.5, 95% CI 1.2-5.2, P = .018], obesity [aOR 1.9, 95% CI 1.0-3.4, P = .039]) and presenting findings (lymphopenia [aOR 1.9, 95% CI 1.1-3.5, P = .033], abnormal chest imaging [aOR 2.9, 95% CI 1.1-7.5, P = .027]) were independently associated with mortality. Multiple measures of immunosuppression intensity were not associated with mortality. CONCLUSIONS: Mortality among SOT recipients hospitalized for COVID-19 was 20.5%. Age and underlying comorbidities rather than immunosuppression intensity-related measures were major drivers of mortality.
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to significant reductions in transplantation, motivated in part by concerns of disproportionately more severe disease among solid organ transplant (SOT) recipients. However, clinical features, outcomes, and predictors of mortality in SOT recipients are not well described. METHODS: We performed a multicenter cohort study of SOT recipients with laboratory-confirmed COVID-19. Data were collected using standardized intake and 28-day follow-up electronic case report forms. Multivariable logistic regression was used to identify risk factors for the primary endpoint, 28-day mortality, among hospitalized patients. RESULTS: Four hundred eighty-two SOT recipients from >50 transplant centers were included: 318 (66%) kidney or kidney/pancreas, 73 (15.1%) liver, 57 (11.8%) heart, and 30 (6.2%) lung. Median age was 58 (interquartile range [IQR] 46-57), median time post-transplant was 5 years (IQR 2-10), 61% were male, and 92% had ≥1 underlying comorbidity. Among those hospitalized (376 [78%]), 117 (31%) required mechanical ventilation, and 77 (20.5%) died by 28 days after diagnosis. Specific underlying comorbidities (age >65 [adjusted odds ratio [aOR] 3.0, 95% confidence interval [CI] 1.7-5.5, P < .001], congestive heart failure [aOR 3.2, 95% CI 1.4-7.0, P = .004], chronic lung disease [aOR 2.5, 95% CI 1.2-5.2, P = .018], obesity [aOR 1.9, 95% CI 1.0-3.4, P = .039]) and presenting findings (lymphopenia [aOR 1.9, 95% CI 1.1-3.5, P = .033], abnormal chest imaging [aOR 2.9, 95% CI 1.1-7.5, P = .027]) were independently associated with mortality. Multiple measures of immunosuppression intensity were not associated with mortality. CONCLUSIONS: Mortality among SOT recipients hospitalized for COVID-19 was 20.5%. Age and underlying comorbidities rather than immunosuppression intensity-related measures were major drivers of mortality.
Authors: Vinay Nair; Nicholas Jandovitz; Jamie S Hirsch; Mersema Abate; Sanjaya K Satapathy; Nitzan Roth; Santiago J Miyara; Sara Guevara; Adam M Kressel; Alec Xiang; Grace Wu; Samuel D Butensky; David Lin; Stephanie Williams; Madhu C Bhaskaran; David T Majure; Elliot Grodstein; Lawrence Lau; Gayatri Nair; Ahmed E Fahmy; Aaron Winnick; Nadine Breslin; Ilan Berlinrut; Christine Molmenti; Lance B Becker; Prashant Malhotra; Pranisha Gautam-Goyal; Brian Lima; Simon Maybaum; Samit K Shah; Ryosuke Takegawa; Kei Hayashida; Koichiro Shinozaki; Lewis W Teperman; Ernesto P Molmenti Journal: Am J Transplant Date: 2020-12-16 Impact factor: 8.086
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Authors: Olivia S Kates; Robert M Rakita; Erika D Lease; Cynthia E Fisher; Ajit P Limaye Journal: Clin Infect Dis Date: 2021-11-02 Impact factor: 9.079
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