2700. Reducing the Dose of Mycophenolate in Solid Organ Transplant Recipients Diagnosed with SARS-CoV-2 Infection Increases the Risk of Severe COVID-19

Abstract

Abstract Background Most of the available COVID-19 outcome data in solid organ transplant (SOT) recipients does not suggest a higher mortality rate in the SOT population. Though theoretically immunosuppressive medications might be associated with worse outcome, its immunomodulatory effect might be beneficial. Methods We retrospectively analyzed the effect of dose-reduction of mycophenolate, tacrolimus, and prednisone on the severity of COVID-19 in SOT recipients diagnosed with COVID-19 at the University of Kansas Medical Center between January 1, 2020 and December 31, 2022. Severe COVID-19 was defined by development of hypoxia while the patient was on room air during a 21-day period following COVID-19 diagnosis. To evaluate the effect of dose changes after the diagnosis of COVID-19 on the odds of developing severe COVID-19, we subset our data based on whether patients were taking mycophenolate (n = 449), tacrolimus (n = 537) or prednisone (n = 386) at the time of diagnosis. Within each subgroup, we fit a logistic regression model with severe COVID-19 as the response variable and adjusted for the relevant immunosuppressant and a set of covariates (age, sex, race, body mass index, hypertension, diabetes mellitus, prespecified time period of COVID-19 diagnosis during the pandemic, chronic heart disease, chronic lung disease, malignancy, end stage renal disease, cirrhosis, smoking, receipt of COVID-19 vaccine, and receipt of SARS-CoV-2 monoclonal antibodies). Results In our SOT population, 570 patients were diagnosed with COVID-19 (458 kidney, 73 liver, 54 heart, 43 pancreas, and 8 lung recipients). The median patient age was 54 years, 59% were male, and 70% were white. After adjusting for other covariates, a mycophenolate dose-reduction of < 50% was associated with an odds ratio of 2.01 (95% CI: 1.03 - 3.90; p = 0.04) for developing severe COVID-19. Similarly, decreasing the dose of mycophenolate by ≥ 50% was associated with an odds ratio of 2.65 (95% CI: 1.09 - 6.41, p = 0.03) for developing severe disease. Tacrolimus dose reduction did not increase the risk of severe COVID-19, nor did a dose increase or decrease of prednisone. Conclusion A mycophenolate dose reduction when a SOT patient is diagnosed with COVID-19 should be discouraged, especially if the patient has mild disease. Disclosures All Authors: No reported disclosures