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Published on: August 15, 2022
COVID-19 mortality among solid organ transplant recipients and candidates before specific vaccine availability in
Yazmin R Arias-Murillo1, Maria A Salinas-Nova1, Miguel Á Castro-Jiménez1
1National Coordination of the Donation and Transplant Network. Blood Bank, Transfusion, and Transplant Research Group, Instituto Nacional de Salud (National Institute of Health), Bogotá, Colombia.
Insights
Organ transplant recipients and waitlisted patients faced high COVID-19 infection and mortality rates. Case-fatality ratios were significantly higher in transplant recipients before vaccines became available.
Area of Science:
- Transplant medicine
- Infectious disease epidemiology
Background:
- Organ transplant recipients are highly vulnerable to severe outcomes from COVID-19.
- The early pandemic period, before vaccine availability, posed significant risks.
Purpose of the Study:
- To determine COVID-19 infection rates, mortality, and case-fatality ratios (CFR) in solid organ transplant recipients and waitlisted patients.
- To assess the impact of COVID-19 on this vulnerable population prior to widespread vaccination.
Main Methods:
- Observational study utilizing official COVID-19 reporting data.
- Calculation of infection positivity, mortality counts, CFR, and all-cause mortality.
- Comparison of outcomes between transplant recipients and waitlisted patients.
Main Results:
- 26.2% of 2,551 subjects tested positive for SARS-CoV-2.
- COVID-19-related mortality was 4.7%; overall mortality was 10.4%.
- Transplant recipients had a higher CFR (21.4%) than waitlisted patients (17.1%), with significantly higher COVID-19 mortality probability (87.3% vs 73%).
Conclusions:
- COVID-19 significantly increased mortality among solid organ transplant recipients and waitlisted patients in Colombia during the pandemic's first year.
- The findings highlight the critical vulnerability of transplant candidates and recipients to severe COVID-19 outcomes.
- These results underscore the importance of protective measures for immunocompromised populations during infectious disease outbreaks.
Introduction:
Coronavirus disease 2019 (COVID-19) is a life-threatening disease that was declared a pandemic in March 2020. Organ transplant recipients are vulnerable to infection and complications from COVID-19. The objective of this study was to investigate the rates of infection, mortality, and case-fatality ratios (CFR) in solid organ transplant recipients and patients on the waiting list for organ allocation in the period prior to the availability of specific vaccines.
Methodology:
This was an observational study of official sources that are used to report information on COVID-19. Quantitative variables were described with arithmetic means and categorical variables with proportions. Percentages of positivity to infection, number of deaths, CFR, and all-cause mortality were calculated for each group and subgroup.
Results:
There were 2,551 eligible subjects; 602 (26.2%) were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There were 265 (10.4%) deaths from all causes during the follow-up period; 119 (44.9%) of them were associated with COVID-19, which indicated a COVID-19-related mortality rate of 4.7 %. CFRs were 21.4% and 17.1% in transplant recipients and waitlisted patients, respectively. CFR was significantly higher in transplant recipients (23.8%) than in patients waitlisted for kidney (16.5%; p = 0.044) Among SARS-CoV-2-positive patients, the probability of dying from COVID-19 was higher in the first group (87.3% and 73%, respectively; p = 0.034).
Conclusions:
COVID-19 had a significant impact on the deaths of transplant patients and patients on the solid organ waiting list during the first year of the pandemic in Colombia, before the availability of vaccines.
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