Outcomes of critically ill solid organ transplant patients with COVID-19 in the United States

Miklos Z Molnar, Anshul Bhalla, Ambreen Azhar, Makoto Tsujita, Manish Talwar, Vasanthi Balaraman, Amik Sodhi, Dipen Kadaria, James D Eason, Salim S Hayek, Steven G Coca, Shahzad Shaefi, Javier A Neyra, Shruti Gupta, David E Leaf, Csaba P Kovesdy, STOP-COVID Investigators

Abstract

National data on patient characteristics, treatment, and outcomes of critically ill coronavirus disease 2019 (COVID-19) solid organ transplant (SOT) patients are limited. We analyzed data from a multicenter cohort study of adults with laboratory-confirmed COVID-19 admitted to intensive care units (ICUs) at 68 hospitals across the United States from March 4 to May 8, 2020. From 4153 patients, we created a propensity score matched cohort of 386 patients, including 98 SOT patients and 288 non-SOT patients. We used a binomial generalized linear model (log-binomial model) to examine the association of SOT status with death and other clinical outcomes. Among the 386 patients, the median age was 60 years, 72% were male, and 41% were black. Death within 28 days of ICU admission was similar in SOT and non-SOT patients (40% and 43%, respectively; relative risk [RR] 0.92; 95% confidence interval [CI]: 0.70-1.22). Other outcomes and requirement for organ support including receipt of mechanical ventilation, development of acute respiratory distress syndrome, and receipt of vasopressors were also similar between groups. There was a trend toward higher risk of acute kidney injury requiring renal replacement therapy in SOT vs. non-SOT patients (37% vs. 27%; RR [95% CI]: 1.34 [0.97-1.85]). Death and organ support requirement were similar between SOT and non-SOT critically ill patients with COVID-19.

Keywords: clinical research/practice; complication: infectious; infection and infectious agents - viral; infectious disease; kidney transplantation/nephrology; organ transplantation in general; patient survival.

© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.

Figures

FIGURE 1
FIGURE 1
Flow chart of patient selection. COVID-19, coronavirus disease 2019; SOT, solid organ transplantation; ICU, intensive care unit; ESRD, end-stage renal disease

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Source: PubMed

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