Risk factors for unfavorable outcome and impact of early post-transplant infection in solid organ recipients with COVID-19: A prospective multicenter cohort study.

Sonsoles Salto‐Alejandre ,José María Aguado,María Carmen Fariñas,Maricela Valerio,Pilar Martín-Dávila,Elisa Vidal,Francisco Arnaiz-Revillas,Jorge Calderón-Parra,María Ángeles Marcos,Laura Linares,Elisa Cordero,Silvia Jiménez-Jorge,Jerónimo Pachón,Elena García De Vinuesa-Calvo,Rosa Blanes-Hernández,J Torre-Cisneros ,Núria Sabé ,Román Hernández-Gallego ,Jesus Fortún-Abete ,Rosa Blanes ,Luis Eduardo López-Cortés ,Mario Fernández‐Ruiz ,Clara Rosso-Fernández ,Javier Sánchez‐Céspedes ,Jordi Carratalà ,Antonio Ramos‐Martínez ,Patricia Muñóz ,Zaira R Palacios‐Baena

doi:10.1371/journal.pone.0250796

Abstract

The aim was to analyze the characteristics and predictors of unfavorable outcomes in solid organ transplant recipients (SOTRs) with COVID-19. We conducted a prospective observational cohort study of 210 consecutive SOTRs hospitalized with COVID-19 in 12 Spanish centers from 21 February to 6 May 2020. Data pertaining to demographics, chronic underlying diseases, transplantation features, clinical, therapeutics, and complications were collected. The primary endpoint was a composite of intensive care unit (ICU) admission and/or death. Logistic regression analyses were performed to identify the factors associated with these unfavorable outcomes. Males accounted for 148 (70.5%) patients, the median age was 63 years, and 189 (90.0%) patients had pneumonia. Common symptoms were fever, cough, gastrointestinal disturbances, and dyspnea. The most used antiviral or host-targeted therapies included hydroxychloroquine 193/200 (96.5%), lopinavir/ritonavir 91/200 (45.5%), and tocilizumab 49/200 (24.5%). Thirty-seven (17.6%) patients required ICU admission, 12 (5.7%) suffered graft dysfunction, and 45 (21.4%) died. A shorter interval between transplantation and COVID-19 diagnosis had a negative impact on clinical prognosis. Four baseline features were identified as independent predictors of intensive care need or death: advanced age, high respiratory rate, lymphopenia, and elevated level of lactate dehydrogenase. In summary, this study presents comprehensive information on characteristics and complications of COVID-19 in hospitalized SOTRs and provides indicators available upon hospital admission for the identification of SOTRs at risk of critical disease or death, underlining the need for stringent preventative measures in the early post-transplant period.

Highlights

In December 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causative agent of coronavirus disease 2019 (COVID-19), emerged in China [1]
Prospective, nationwide study of solid organ transplant recipients (SOTRs) hospitalized with COVID-19 followed for 30 days, 17.6% required intensive care unit (ICU) admission, and the mortality rate was 21.4%
An earlier post-transplant SARS-CoV-2 infection was demonstrated as a risk factor for unfavorable outcomes

Summary

Introduction

In December 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causative agent of coronavirus disease 2019 (COVID-19), emerged in China [1]. It spread globally, becoming a public health emergency and a pandemic of historic dimensions [2]. Despite widespread concern that COVID-19 clinical phenotypes may be more severe among solid organ transplant recipients (SOTRs) due to a poorer inflammatory response and greater organ injury, data on this population are limited to a few case series and generally small retrospective cohorts [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25]

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