ABSTRACT
Background: Solid organ transplant (SOT) recipients are considered to be 'vulnerable' to COVID-19 infection due to immunosuppression To date, there are no studies that compared the disease severity of COVID-19 in SOT recipients with non-SOT COVID-19 patients We characterized COVID-19 illness and clinical course among SOT recipients and compared the COVID-19 outcomes between SOT recipients and matched non-SOT patients Methods: In this case-control study, we compared the outcomes of COVID-19 between SOT recipients (cases: N=41) and their matched non-SOT (controls: N=121) patients from our center between 3/10/20 and 5/15/20 SOT recipients with COVID-19 were matched with up to three non-SOT COVID-19 controls on age (±5years), race, and admission status Patients were followed up until death or June 10, 2020 The primary outcome was death and secondary outcomes were severe diseasedefined as transfer to the intensive care unit and requiring at least humidified high flow oxygen), intubation and renal replacement therapy (RRT) use Results: The SOT recipients had the following transplants: 9 heart, 3 lung, 16 kidney, 8 liver and 5 dual organ (2 kidney-pancreas,1 heart-kidney, 1 liver-kidney, 1 kidney after liver) with a median age of 60 years (54-69), 80% male, 67% Black, 92% hypertension, 51% diabetes and 80% chronic kidney disease (CKD) Median time from transplant to COVID-19 was 9 years (5-16) Fortyfour percent of SOT COVID-19 had severe disease (61% renal replacement therapy [RRT], 61% intubation and 11% ECMO) The overall (14 6% vs 11 4%, P=NS) and severe disease (33% vs 29%;p=NS) case fatality rates were similar in SOT and non-SOT with COVID-19 Organ type did not predict the severe disease or death in SOT-recipients Risk of death was similar between SOT and non-SOT matched COVID-19 patients (HR=0 84[0 32, 2 20]) after adjusting for disease severity RRT use was higher in SOT recipients than matched non-SOT with COVID-19 (adjusted OR=5 32 [1 26, 22 42]) after adjusting for baseline CKD Tocilizumab use was higher in SOT than non-SOT COVID-19 patients (27% vs 9%, P=0 01) Hydroxychloroquine (HCQ) use for COVID-19 was similar (28% vs 29%;p=0 89) in both the groups Among SOT recipients, those treated with HCQ for COVID-19 had a ten-fold higher hazard of death compared to those who did not receive HCQ (HR=10 62[1 24, 91 09]) (Figure 1) This effect was not seen in non-SOT matched controls with COVID-19 Conclusion: Blacks and Males SOT recipients affected disproportionately with COVID-19 Black constitute one-tenth of all SOT in our center yet they represented two-thirds of COVID-19 cases Despite high RRT use in SOT recipients, the severe disease and short-term death were similar in both groups HCQ for the treatment of COVID-19 among SOT recipients was associated with high mortality and therefore, its role as a treatment modality requires further scrutiny(Figure Presented).