COVID-19 Outcomes Among Solid Organ Transplant Recipients: A Case-control Study

Area of Science:

• Immunology
• Infectious Diseases
• Nephrology

Background:

• Solid organ transplant (SOT) recipients are immunocompromised and considered vulnerable to severe COVID-19.
• No prior studies have directly compared COVID-19 disease severity between SOT recipients and non-transplant individuals.

Purpose of the Study:

• To compare COVID-19 outcomes between SOT recipients and matched non-transplant controls.
• To identify risk factors for severe COVID-19 and mortality in SOT recipients.

Main Methods:

• A case-control study comparing 41 SOT recipients with 121 matched non-transplant patients diagnosed with COVID-19.
• Matching criteria included age, race, and admission status.
• Primary outcome was death; secondary outcomes included severe disease, intubation, and renal replacement therapy (RRT).

Main Results:

• Adjusted risk of death was similar between groups (HR=0.84).
• COVID-19 severity and intubation rates were comparable, but RRT use was significantly higher in SOT recipients (OR=5.32).
• Hydroxychloroquine (HCQ) use in SOT recipients was associated with a 10-fold increased hazard of death (HR=10.62).

Conclusions:

• SOT recipients and non-transplant patients had similar short-term mortality and severe COVID-19 outcomes.
• African Americans represented a disproportionately high percentage of COVID-19 cases among SOT recipients.
• The high mortality associated with HCQ in SOT recipients warrants further investigation.