Clin Transplant

. 2021 Sep 24;e14492.
doi: 10.1111/ctr.14492. Online ahead of print.
Excess Mortality in Solid Organ Transplant Recipients Hospitalized with COVID-19: A Large-Scale Comparison of SOT Recipients Hospitalized With or Without COVID-19

Karola S Jering 1 2 , Martina M McGrath 2 3 , Finnian R Mc Causland 2 3 , Brian Claggett 1 2 , Jonathan W Cunningham 1 2 , Scott D Solomon 1 2



Background: Solid-organ transplant (SOT) recipients with COVID-19 have higher risk of adverse outcomes compared to the general population. Whether hospitalized SOT recipients with COVID-19 are at higher risk of mortality than SOT recipients hospitalized for other causes, including non-COVID-19 pneumonia, remains unclear.
Methods: We used logistic regression to compare outcomes of SOT recipients hospitalized with COVID-19 to non-COVID-19 related admissions and with non-COVID-19 pneumonia.
Results: Of 17,012 hospitalized SOT recipients, 1,682 had COVID-19. Those with COVID-19 had higher odds of ICU admission (adjusted odds ratio [aOR] 2.12 [95%CI: 1.88-2.39]) and mechanical ventilation (aOR 3.75 [95%CI: 3.24-4.33]). COVID-19 was associated with higher odds of in-hospital death, which was more pronounced earlier in the pandemic (aOR 9.74 [95%CI: 7.08-13.39] for April/May versus aOR 7.08 [95%CI: 5.62-8.93] for June through November 2020; p-interaction = 0.03). Compared to SOT recipients hospitalized with non-COVID-19 pneumonia, odds of in-hospital death were higher in SOT recipients with COVID-19 (aOR 2.44 [95% CI: 1.90-3.13]), regardless of time of hospitalization (p-interaction >0.40).
Conclusions: In this large cohort of SOT recipients, hospitalization with COVID-19 was associated with higher odds of complications and in-hospital mortality than non-COVID-19 related admissions, and 2.5-fold higher odds of in-hospital mortality, compared to SOT recipients with non-COVID-19 pneumonia. This article is protected by copyright. All rights reserved.

Keywords: COVID-19; SARS-CoV-2; Transplant; allograft; coronavirus; heart transplant; kidney transplant; liver transplant; solid-organ.