Immune-Suppression Modulation in Solid Organ Transplant Recipients Admitted for COVID-19

Abstract

SARS-CoV-2 infection has significantly impacted solid organ transplant (SOT) recipients, who are at high risk of disease and worse outcomes. Moreover, therapeutic management in this population is not precise yet. Our study aimed to evaluate the overall survival of SOT recipients and predictive factors for mortality. We also aimed to assess the impact of antiviral treatments and immunosuppressant changes on overall mortality and to evaluate the length of hospital stay of SOT compared to the general population. This is a retrospective monocenter study. We included all SOT recipients with laboratory-confirmed SARS-CoV2 infection admitted at Niguarda Hospital in Milan from February 2020 through January 2022. We enrolled 74 solid organ transplant recipients with a median age of 59. The overall mortality rate was 19%. Older age, male sex, diabetes, and high LDH values were associated with an increasing fatality rate. The median length of stay (LoS) was 17 days. Low white blood count and lymphocyte levels were associated with 19 days LoS. Changes in immunosuppression and SARS-CoV-2 antiviral therapies had no impact on mortality and LoS. In this study, we confirm previously described risk factors for worse outcomes. We did not observe beneficial therapies in terms of mortality rate and LoS. Seven patients received antiviral treatment. More studies are needed to assess the best therapeutical options, including immunosuppressant modulation, in SOTs.