ABSTRACT
Purpose: To understand the outcomes and changes in disease severity of COVID-19 in Solid Organ Transplant (SOT) recipients over time in the context of therapeutic advances. Method(s): We performed a multicenter, prospective cohort study of all SOT recipients diagnosed with COVID-19, across 9 transplant programs in Canada, from March 2020-November 2021. Baseline characteristics, demographics, treatment and disease severity outcomes were collected. The primary outcome was need for supplemental oxygen. Factors associated with the primary outcome and changes in outcomes over time were analyzed. Pandemic time periods were divided into four time frames coinciding with 4 waves in North America. Result(s): We enrolled 509 SOT recipients with confirmed COVID-19 during the study period. The risk factors associated with oxygen requirement are outlined in Table 1. Severe disease and mortality were greatest in lung transplant recipients compared to other organ types (15/48 (31.3%) lung deaths vs 63/461(13.7%) nonlung organs, (p=0.001). There was no influence of 2-dose vaccination and 3 patients were infected after 3-dose vaccine. Disease with alpha or delta variant was not associated with increased oxygen requirement. In a subgroup analysis of participants requiring oxygen (n=190), remdesivir was associated with less death (p=0.035). Over the pandemic period (Figure 1), there were no significant changes in the proportion of patients requiring oxygen, ICU admission, ventilatory support or death. (Table Presented) Conclusion(s): COVID-19 is especially severe in lung transplant recipients and immunosuppression plays a significant role. The outcomes associated with COVID-19 in SOT have not appreciably changed over time despite the emergence of novel variants and changes in therapeutic regimens.
ABSTRACT
Purpose: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted the field of transplantation across Canada. In this study, we outline the implications of COVID-19 related interruptions in kidney transplant activities to Canadian end-stage renal disease (ESRD) patients. Methods: We used an adapted Markov microsimulation model with a 10-year horizon and an ESRD patient perspective to study the effectiveness (patient survival in months) of living (LD) or deceased donor (DD) transplantation vs. halting transplantation for the course of the pandemic. We conducted base case, scenario, and sensitivity analyses to illustrate the impact of patient and donor characteristics as well as SARS-CoV-2 infection rates and pandemic length on the preferred strategy. Results: The base case analysis suggested that LD offered greater effectiveness (99.18 months, 95% CI 98.32-100.04) in comparison to delaying LD and remaining on dialysis for the duration of the pandemic (95.7 months (95% CI 94.80-96.6)). In contrast, DD offered effectiveness of 95.4 months (95% CI 94.50-96.30) in comparison to 94.3 months (95% CI 93.38-95.22) when experiencing interruptions in DD transplant activities for the duration of the pandemic. Infection incidence greater than 1.4% over 5-months, shorter periods of interruptions in transplant activities, younger candidates, delayed pre-emptive transplants and transplantation of donors with higher Kidney Donor Risk Index scores made the DD strategy comparable to delaying transplant activities. Conclusions: Cessation of transplant activity during the COVID-19 pandemic appears to be detrimental to long-term survival of ESRD patients, contributes to organ discard, and worsens the everlasting gap between organ supply and demand. (Table Presented).