COVID-19 in Solid Organ Transplantation: A Matched Retrospective Cohort Study and Evaluation of Immunosuppression Management
Marta Miarons, María Larrosa-García, Sonia García-García, Ibai Los‐Arcos, Francesc Moreso, Cristina Berastegui, Lluı́s Castells, Santiago Pérez‐Hoyos, Javier Prato Varela, Alba Pau‐Parra, C Varon-Galcera, Carlos Javier Parramon‐Teixidó, Javier Martínez-Casanova, Laura Doménech Moral, Patricia García-Ortega, Pablo Sánchez-Sancho, Carla Alonso‐Martínez, Laura Gómez-Ganda, María Roch-Santed, A Gracia-Moya, José-Manuel Del-Rio-Gutiérrez, Alfredo Guillén-Del-Castillo, Carla Sans‐Pola, Andrés Antón, Bruno Montoro, Maria-Queralt Gorgas-Torner, on behalf of the Vall d’Hebron COVID-19 Working Group
Abstract
BACKGROUND: The epidemiological and clinical characteristics of solid organ transplant (SOT) patients during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic remains unclear. We conducted a matched retrospective cohort study to compare clinical outcomes among SOT recipients with the general population and to assess immunosuppression management. METHODS: Adult SOT recipients with laboratory polymerase chain reaction-confirmed SARS-CoV-2 infection admitted to a tertiary-care hospital in Barcelona, Spain, from March 11 to April 25, 2020, were matched to controls (1:4) on the basis of sex, age, and age-adjusted Charlson's Index. Patients were followed for up to 28 days from admission or until censored. Primary endpoint was mortality at 28 days. Secondary endpoints included admission to the intensive care unit and secondary complications. Drug-drug interactions (DDI) between immunosuppressants and coronavirus disease 2019 (COVID-19) management medication were collected. RESULTS: Forty-six transplant recipients and 166 control patients were included. Mean (SD) age of transplant recipients and controls was 62.7 (12.6) and 66.0 (12.7) years, 33 (71.7%) and 122 (73.5%) were male, and median (interquartile range) Charlson's Index was 5 (3-7) and 4 (2-7), respectively. Mortality was 37.0% in SOT recipients and 22.9% in controls (P = 0.51). Thirty-three (71.7%) patients underwent transitory discontinuation of immunosuppressants due to potential or confirmed DDI. CONCLUSIONS: In conclusion, hospitalized SOT recipients with COVID-19 had a trend toward higher mortality compared with controls, although it was not statistically significant, and a notable propensity for DDI.