Elisabeth Coll1, Mario Fernández-Ruiz, María Padilla, Francesc Moreso, Ana Hernández-Vicente, Iñigo Yañez, María Molina, Teresa Vázquez-Sánchez, Marta Crespo, Carme Facundo, Mª Luisa Rodríguez-Ferrero, Mª Carmen Ruiz Fuentes, Carmelo Loinaz, Gabriel Bernal, Edoardo Melilli, Carlos Bravo, Fritz Diekmann, Laura Lladó, Teresa M García-Álvarez, Magdalena Salcedo, Isabel Beneyto, Lluis Castells, Rodrigo Alonso, Alberto Rodríguez-Benot, Carmen Díaz-Corte, Javier Graus, Carlos Ortiz-Bautista, Mª Dolores García-Cosío, Rosa Hinojal, Lucía Peña, Beatriz Domínguez-Gil. 1. 1 Organización Nacional de Trasplantes, Madrid, Spain. 2 Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain. Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). 3 Kidney Transplant Unit. Nephrology Department. Hospital Universitario Vall d´Hebrón, Barcelona, Spain. 4 Nephrology Service. Hospital Universitario 12 de Octubre, Madrid, Spain 5 Nephrology Service. Hospital Universitario de Cruces, Barakaldo, Spain. 6 Nephrology Service. Hospital Germans Trias i Pujol, Badalona, Spain. 7 Nephrology Service. Hospital Regional Universitario de Málaga, Málaga, Spain. 8 Nephrology Service. Hospital del Mar, Barcelona, Spain. Transplant Working Group of the Spanish Society of Nephrology. REDinREN (RD16/0009/0013). 9 Kidney Transplant Unit. Fundación Puigvert, Barcelona, Spain 10 Nephrology Service. Hospital General Universitario Gregorio Marañón, Madrid, Spain. 11 Nephrology Service. Hospital Virgen de las Nieves, Granada, Spain. 12 Hepato-Biliary Surgery and Transplant Unit. General Surgery Service. Hospital Universitario 12 de Octubre, Madrid, Spain. 13 Kidney Transplant Unit, Clinical Management Unit Nephrology-Urology. Hospital Universitario Virgen del Rocío, Sevilla, Spain. 14 Kidney Transplant Unit, Nephrology Service. Hospital Universitario de Bellvitge, Barcelona, Spain. 15 Department of Pulmonology, Lung transplant Unit, Hospital Universitario Vall d´Hebrón, Barcelona, Spain. 16 Kidney Transplant Unit. Nephrology Service. Hospital Clinic, Barcelona, Spain. 17 Liver Transplant Unit. Hospital Universitario de Bellvitge, IDIBELL, Barcelona, Spain. 18 Kidney Transplant Unit, Nephrology Service. Hospital Universitario Puerta del Mar, Cádiz, Spain. 19 Hepatology and Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain. 20 Kidney Transplant Unit, Nephrology Service. Hospital Universitario La Fe, Valencia, Spain. 21 Liver Unit. Hospital Universitario Vall d´Hebron, Barcelona, Spain. Vall d'Hebron Institut de Recerca (VHIR). CIBERehd, Instituto de Salud Carlos III. 22 Lung Transplant Unit. Neumology Service. Hospital Universitario 12 de Octubre, Madrid, Spain. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12). 23 Kidney Transplant Unit, Nephrology Service. Hospital Universitario Reina Sofía, Instituto para la Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain. 24 Kidney Transplant Unit, Nephrology Service. Hospital Universitario Central de Asturias, Oviedo, Spain. 25 Gastroenterology Service. Hospital Universitario Ramón y Cajal, Madrid, Spain. 26 Heart Failure and Transplant Unit. Cardiology Service. Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain. Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV). 27 Cardiology Service, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain. Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV).
Abstract
BACKGROUND: Few studies have analyzed differences in clinical presentation and outcomes in solid organ transplant (SOT) recipients with COVID-19 across different pandemic waves. METHODS: In this multicenter, nationwide, prospective study, we compared demographics and clinical features, therapeutic management and outcomes in SOT recipients diagnosed with COVID-19 in Spain before (first wave) or after (second wave) 13 July 2020. RESULTS: Out of 1634 SOT recipients, 690 (42.2%) and 944 (57.8%) were diagnosed during the first and second period, respectively. Compared with the first wave, recipients in the second were younger (median: 63 [IQR: 53-71] versus 59 [IQR: 49-68] years; p<0.001) and less likely to receive anti-SARS-CoV-2 drugs (81.8% versus 8.1%; p<0.001), with no differences in immunomodulatory therapies (46.8% versus 47.0%; p=0.931). Adjustment of immunosuppression was less common during the second period (76.4% versus 53.6%; p<0.001). Hospital admission (86.7% versus 58.1%; p<0.001), occurrence of acute respiratory distress syndrome (34.1% versus 21.0%; p<0.001), and case-fatality rate (25.8% versus 16.7%; p<0.001) were lower in the second period. In multivariate analysis, acquiring COVID-19 during the first wave was associated with an increased risk of death (OR: 1.47; 95% CI: 1.12-1.93; p=0.005), although this impact was lost in the subgroup of patients requiring hospital (OR: 0.97; 95% CI: 0.73-1.29; p=0.873) or intensive care unit (ICU) admission (OR: 0.65; 95% CI: 0.35-1.18; p=0.157). CONCLUSIONS: We observed meaningful changes in demographics, therapeutic approaches, level of care and outcomes between the first and second pandemic waves. However, outcomes have not improved in the more severe cases of posttransplant COVID-19.
BACKGROUND: Few studies have analyzed differences in clinical presentation and outcomes in solid organ transplant (SOT) recipients with COVID-19 across different pandemic waves. METHODS: In this multicenter, nationwide, prospective study, we compared demographics and clinical features, therapeutic management and outcomes in SOT recipients diagnosed with COVID-19 in Spain before (first wave) or after (second wave) 13 July 2020. RESULTS: Out of 1634 SOT recipients, 690 (42.2%) and 944 (57.8%) were diagnosed during the first and second period, respectively. Compared with the first wave, recipients in the second were younger (median: 63 [IQR: 53-71] versus 59 [IQR: 49-68] years; p<0.001) and less likely to receive anti-SARS-CoV-2 drugs (81.8% versus 8.1%; p<0.001), with no differences in immunomodulatory therapies (46.8% versus 47.0%; p=0.931). Adjustment of immunosuppression was less common during the second period (76.4% versus 53.6%; p<0.001). Hospital admission (86.7% versus 58.1%; p<0.001), occurrence of acute respiratory distress syndrome (34.1% versus 21.0%; p<0.001), and case-fatality rate (25.8% versus 16.7%; p<0.001) were lower in the second period. In multivariate analysis, acquiring COVID-19 during the first wave was associated with an increased risk of death (OR: 1.47; 95% CI: 1.12-1.93; p=0.005), although this impact was lost in the subgroup of patients requiring hospital (OR: 0.97; 95% CI: 0.73-1.29; p=0.873) or intensive care unit (ICU) admission (OR: 0.65; 95% CI: 0.35-1.18; p=0.157). CONCLUSIONS: We observed meaningful changes in demographics, therapeutic approaches, level of care and outcomes between the first and second pandemic waves. However, outcomes have not improved in the more severe cases of posttransplant COVID-19.
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