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Updated: Aug 19, 2025
Investigating the Immunological Mechanisms Underlying Organ Transplant Rejection
Published on: August 20, 2007
Incidence, Risk Factors, and Outcomes of COVID-19 Infection in a Large Cohort of Solid Organ Transplant Recipients
Amandeep Sahota1, Andy Tien1, Janis Yao2
1Department of Transplant Hepatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA.
Insights
Solid organ transplant recipients (SOTr) face higher COVID-19 hospitalization and mortality risks. Lung transplant recipients had the highest mortality, while liver recipients had the lowest.
Area of Science:
- Immunology
- Infectious Diseases
- Transplantation Medicine
Background:
- Solid organ transplant recipients (SOTr) exhibit a heightened vulnerability to severe outcomes from coronavirus disease 2019 (COVID-19) compared to the general population.
- This increased risk underscores the need for targeted monitoring and preventive strategies in this immunocompromised group.
Purpose of the Study:
- To investigate the incidence, hospitalization rates, and mortality associated with COVID-19 among solid organ transplant recipients (SOTr).
- To compare COVID-19 outcomes between SOTr and non-SOTr, and to analyze variations in outcomes among different types of solid organ transplants.
Main Methods:
- A retrospective cohort study was conducted from March 2020 to March 2021, analyzing data from 5126 SOTr within a large integrated healthcare system.
- COVID-19 incidence, hospitalization, and mortality rates were compared between SOTr and non-SOTr, with further stratification by transplant organ type.
- Multivariate analyses identified risk factors for COVID-19-related mortality and hospitalization in SOTr.
Main Results:
- The per person-year incidence of COVID-19 was higher in SOTr (10.0%) than in non-SOTr (7.6%).
- SOTr with COVID-19 experienced significantly higher rates of hospitalization (39.5% vs. 6.0%), ICU admission (29.1% vs. 15.5%), and mortality (14.7% vs. 1.8%) compared to non-SOTr.
- Older age, male gender, and higher BMI were associated with increased COVID-19 mortality in SOTr. COVID-19 mortality risk was lowest in liver recipients and highest in lung recipients.
Conclusions:
- Solid organ transplant recipients (SOTr) face significantly elevated risks of hospitalization and mortality from COVID-19.
- Outcomes and incidence of COVID-19 varied considerably among different types of solid organ transplant recipients, highlighting the importance of transplant-specific risk assessment.
Background:
Solid organ transplant recipients (SOTr) are at increased risk for severe disease from coronavirus disease 2019 (COVID-19) compared with non-SOTr.
Methods:
We performed a retrospective cohort study between March 1, 2020, and March, 30, 2021, in an integrated healthcare system with 4.3 million members aged ≥18 y including 5126 SOTr. Comparisons in COVID-19 mortality, hospitalization, and incidence were made between SOTr and non-SOTr, and between different SOTr organs. Multivariate analysis was performed to identify risk factors for COVID-19 mortality and hospitalization.
Results:
There were 600 SOTr (kidney, liver, heart, and lung) with COVID-19. Per person-year incidence of COVID-19 among SOTr was 10.0% versus 7.6% among non-SOTr (P < 0.0001). Compared with uninfected SOTr, infected SOTr were older (57.1 ± 14.0 versus 45.7 ± 17.9 y, P < 0.001), predominantly Hispanic/Latino (58.8% versus 38.6%, P < 0.0001), hypertensive (77.0% versus 23.8%; P < 0.0001), and diabetic (49.6% versus 13.0%; P = 0.0009). Compared with non-SOTr, infected SOTr had higher hospitalization (39.5% versus 6.0%; P < 0.0001), intensive care unit admission (29.1% versus 15.5%; P < 0.0001), and mortality (14.7% versus 1.8%; P < 0.0001) from COVID-19. Older age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.05-1.10), male gender (HR, 1.79; 95% CI, 1.11-2.86), and higher body mass index (HR, 1.04; 95% CI, 1.00-1.09; P = 0.047) were associated with increased mortality from COVID-19, whereas race, diabetes, and number/type of immunosuppressive medications were not. Among the different SOTr, COVID-19 mortality risk was lowest in liver recipients (HR, 0.34; 95% CI, 0.16-0.73) and highest in lung recipients (HR, 1.74; 95% CI, 0.68-4.42).
Conclusions:
SOTr have higher rates of hospitalization and mortality from COVID-19 compared with the general population. Among the SOTr, the incidence and outcomes were distinct among different transplantation types.
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