Excess mortality in COVID-19-affected solid organ transplant recipients across the pandemic
Shigeyoshi Yamanaga, Keita Shimata, Satoko Ohfuji, Mikiko Yoshikawa, Yoichiro Natori, Taizo Hibi, Kenji Yuzawa, Hiroto Egawa, Kohei Unagami, Hideki Ishida, Kazuya Omoto, Mureo Kasahara, Hajime Uchida, Seisuke Sakamoto, Kenta Futamura, Kenta Nishikawa, Ryoichi Imamura, Shigeaki Nakazawa, Etsuro Hatano, T. Ito, Yuki Masano, Morikuni Nishihira, Yuta Hirata, Yasunaru Sakuma, Yasuharu Onishi, Naoki Yokoyama, S. Yamamoto, Yusuke Yamada, Yasuhiro Ogura, Nobuhiko Kurata, Junji Uchida, Kazuya Kabei, Hitoshi Iwamoto, Chie Ikeda, Kazunobu Shinoda, Miki Yoshiike, Kiyohiko Hotta, Yuji Hidaka, Daiki Iwami, Yasuo Ishíi, Manabu Kamiyama, Tomoharu Yoshizumi, Yukiko Kosai‐Fujimoto, Takaaki Kobayashi, Kentaro Motoyama, Megumi Yamamoto, Toshihiro Asai, Masayuki Tasaki, Takashi Kenmochi, T. Ito, Kazuaki Tokodai, Atsushi Fujio, Yasumasa Tsukamoto, Takuya Watanabe, Nobuhisa Akamatsu, Sachi Yamashina, Daisuke Ishii, Kazuki Kitajima, Yasutoshi Yamada, Akihiko Mitsuke, Takashi Sakaguchi, Michio Nakamura, Yusuke Tomita, Yuki Nakamura, Tatsuro Ishimoto, Hideki Ohdan, Naoki Tanimine, Takuzo Fujiwara, Mitsuki Yanagihara, Shingo Hatakeyama, Manabu Takai, Kazuhiro Nose, Takashi Kikuchi, Yasunori Mori, Motoo Araki, Takanori Sekito, Shingo Nishimura, Tatsu Tanabe, Yuto Igarashi, Sumi Hidaka, Masaaki Watanabe, Yuichi Ariyoshi, Yasushi Hasegawa, Masato Kamiyama, Tatsuo Yoneda, Tomokazu Shimizu, Kouhei Nishikawa, Takumi Fukumoto, K Kuramitsu, Masashi Kato, Mitsuru Saito, M. Shinkai, Hidehito Usui, Masaaki Sato, Hidetoshi Eguchi, Hiroki Imamura, Shogo Kobayashi, Yuji Soejima, Atsuyoshi Mita, Takashi Kobayashi
Abstract
The excess mortality of coronavirus disease 2019 (COVID-19) solid organ transplant recipients (SOTRs) throughout the pandemic remains unclear. This prospective cohort study based on the Japanese nationwide registry included 1632 SOTRs diagnosed with COVID-19 between February 1, 2020, and July 31, 2022, categorized based on dominant phases of variants of concern (VOCs): Waves 1 to 3 (Beta), 4 (Alpha), 5 (Delta), 6 (Omicron BA.1/BA.2), and 7 (Omicron BA.5). Excess mortality of COVID-19-affected SOTRs was analyzed by calculating standardized mortality ratios (SMRs). Overall, 1632 COVID-19-confirmed SOTRs included 1170 kidney, 408 liver, 25 lung, 20 heart, 1 small intestine, and 8 multiorgan recipients. Although disease severity and all-cause mortality decreased as VOCs transitioned, SMRs of SOTRs were consistently higher than those of the general population throughout the pandemic, showing a U-shaped gap that peaked toward the Omicron BA.5 phase; SMR (95% CI): 6.2 (3.1-12.5), 4.0 (1.5-10.6), 3.0 (1.3-6.7), 8.8 (5.3-14.5), and 21.9 (5.5-87.6) for Waves 1 to 3 (Beta), Wave 4 (Alpha), Wave 5 (Delta), Wave 6 (Omicron BA.1/2), and Wave 7 (Omicron BA.5), respectively. In conclusion, COVID-19 SOTRs had greater SMRs than the general population across the pandemic. Vaccine boosters, immunosuppression optimization, and other protective measures, particularly for older SOTRs, are paramount.