Madeleine R Heldman1,2, Olivia S Kates3, Kassem Safa4, Camille N Kotton4, Ashrit Multani5, Sarah J Georgia4, Julie M Steinbrink6, Barbara D Alexander6, Emily A Blumberg7, Brandy Haydel8, Vagish Hemmige9, Marion Hemmersbach-Miller10, Ricardo M La Hoz11, Lisset Moni12, Yesabeli Condor12, Sandra Flores12, Carlos G Munoz12, Juan Guitierrez12, Esther I Diaz12, Daniela Diaz12, Rodrigo Vianna12, Giselle Guerra12, Matthias Loebe12, Julie M Yabu5, Kailey Hughes Kramer13, Sajal D Tanna14, Michael G Ison14, Robert M Rakita1, Maricar Malinis15, Marwan M Azar15, Margaret E McCort8, Pooja P Singh16, Arzu Velioglu17, Sapna A Mehta18, David van Duin19, Jason D Goldman1,20, Erika D Lease21, Anna Wald1,2,22,23, Ajit P Limaye1,23, Cynthia E Fisher1. 1. Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA. 2. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. 3. Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA. 4. Massachusetts General Hospital, Boston, MA, USA. 5. Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. 6. Division of Infectious Diseases, Duke University, Durham, NC, USA. 7. Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. 8. Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 9. Division of Infectious Disease, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY, USA. 10. Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA. 11. Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA. 12. University of Miami/Jackson Memorial Hospital, Miami, FL, USA. 13. Transplant Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, USA. 14. Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 15. Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA. 16. Division of Nephrology, University of New Mexico, Albuquerque, NM, USA. 17. Marmara University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey. 18. NYU Langone Transplant Institute, New York, NY, USA. 19. Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA. 20. Swedish Medical Center, Seattle, WA, USA. 21. Division of Pulmonology, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA. 22. Department of Epidemiology, University of Washington, Seattle, WA, USA. 23. Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA.
Abstract
INTRODUCTION: Most studies of solid organ transplant (SOT) recipients with COVID-19 focus on outcomes within one month of illness onset. Delayed mortality in SOT recipients hospitalized for COVID-19 has not been fully examined. METHODS: We used data from a multicenter registry to calculate mortality by 90 days following initial SARS-CoV-2 detection in SOT recipients hospitalized for COVID-19 and developed multivariable Cox proportional-hazards models to compare risk factors for death by days 28 and 90. RESULTS: Vital status at day 90 was available for 936 of 1117 (84%) SOT recipients hospitalized for COVID-19: 190 of 936 (20%) died by 28 days and an additional 56 of 246 deaths (23%) occurred between days 29 and 90. Factors associated with mortality by day 90 included: age > 65 years [aHR 1.8 (1.3-2.4), p =<0.001], lung transplant (vs. non-lung transplant) [aHR 1.5 (1.0-2.3), p=0.05], heart failure [aHR 1.9 (1.2-2.9), p=0.006], chronic lung disease [aHR 2.3 (1.5-3.6), p<0.001] and body mass index ≥ 30 kg/m 2 [aHR 1.5 (1.1-2.0), p=0.02]. These associations were similar for mortality by day 28. Compared to diagnosis during early 2020 (March 1-June 19, 2020), diagnosis during late 2020 (June 20-December 31, 2020) was associated with lower mortality by day 28 [aHR 0.7 (0.5-1.0, p=0.04] but not by day 90 [aHR 0.9 (0.7-1.3), p=0.61]. CONCLUSIONS: In SOT recipients hospitalized for COVID-19, >20% of deaths occurred between 28 and 90 days following SARS-CoV-2 diagnosis. Future investigations should consider extending follow-up duration to 90 days for more complete mortality assessment.
INTRODUCTION: Most studies of solid organ transplant (SOT) recipients with COVID-19 focus on outcomes within one month of illness onset. Delayed mortality in SOT recipients hospitalized for COVID-19 has not been fully examined. METHODS: We used data from a multicenter registry to calculate mortality by 90 days following initial SARS-CoV-2 detection in SOT recipients hospitalized for COVID-19 and developed multivariable Cox proportional-hazards models to compare risk factors for death by days 28 and 90. RESULTS: Vital status at day 90 was available for 936 of 1117 (84%) SOT recipients hospitalized for COVID-19: 190 of 936 (20%) died by 28 days and an additional 56 of 246 deaths (23%) occurred between days 29 and 90. Factors associated with mortality by day 90 included: age > 65 years [aHR 1.8 (1.3-2.4), p =<0.001], lung transplant (vs. non-lung transplant) [aHR 1.5 (1.0-2.3), p=0.05], heart failure [aHR 1.9 (1.2-2.9), p=0.006], chronic lung disease [aHR 2.3 (1.5-3.6), p<0.001] and body mass index ≥ 30 kg/m 2 [aHR 1.5 (1.1-2.0), p=0.02]. These associations were similar for mortality by day 28. Compared to diagnosis during early 2020 (March 1-June 19, 2020), diagnosis during late 2020 (June 20-December 31, 2020) was associated with lower mortality by day 28 [aHR 0.7 (0.5-1.0, p=0.04] but not by day 90 [aHR 0.9 (0.7-1.3), p=0.61]. CONCLUSIONS: In SOT recipients hospitalized for COVID-19, >20% of deaths occurred between 28 and 90 days following SARS-CoV-2 diagnosis. Future investigations should consider extending follow-up duration to 90 days for more complete mortality assessment.
Authors: Shweta Anjan; Akshay Khatri; Julia Bini Viotti; Teresa Cheung; Leopoldo A Cordova Garcia; Jacques Simkins; Matthias Loebe; Anita Phancao; Christopher B O'Brien; Neeraj Sinha; Gaetano Ciancio; Rodrigo M Vianna; David Andrews; Lilian M Abbo; Giselle Guerra; Yoichiro Natori Journal: Transpl Infect Dis Date: 2022-08-01