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COVID-19 in solid organ transplant recipients: A national cohort study from Sweden |
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| Authors: | John M. Søfteland Gustav Friman Bengt von Zur-Mühlen Bo-Göran Ericzon Carin Wallquist Kristjan Karason Vanda Friman Jan Ekelund Marie Felldin Jesper Magnusson Ida Haugen Löfman Andreas Schult Emily de Coursey Susannah Leach Hanna Jacobsson Jan-Åke Liljeqvist Ali R. Biglarnia Per Lindnér Mihai Oltean |
| Affiliation: | 1. The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden;2. Department of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden;3. Department of Transplantation Surgery, Uppsala University Hospital, Uppsala, Sweden;4. Department of Nephrology, Skåne University Hospital, Malmö, Sweden;5. Department of Infectious Diseases, Institute of Biomedicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;6. Centre of Registers, Västra Götaland, Gothenburg, Sweden;7. Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden;8. Department of Microbiology and Immunology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg, Sweden;9. The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden Biobank West, Sahlgrenska University Hospital, Gothenburg, Sweden;10. Department of Transplantation Surgery, Skåne University Hospital, Malmö, Sweden;11. The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden |
| Abstract: | Solid organ transplant (SOT) recipients run a high risk for adverse outcomes from COVID-19, with reported mortality around 19%. We retrospectively reviewed all known Swedish SOT recipients with RT-PCR confirmed COVID-19 between March 1 and November 20, 2020 and analyzed patient characteristics, management, and outcome. We identified 230 patients with a median age of 54.0 years (13.2), who were predominantly male (64%). Most patients were hospitalized (64%), but 36% remained outpatients. Age >50 and male sex were among predictors of transition from outpatient to inpatient status. National early warning Score 2 (NEWS2) at presentation was higher in non-survivors. Thirty-day all-cause mortality was 9.6% (15.0% for inpatients), increased with age and BMI, and was higher in men. Renal function decreased during COVID-19 but recovered in most patients. SARS-CoV-2 antibodies were identified in 78% of patients at 1–2 months post-infection. Nucleocapsid-specific antibodies decreased to 38% after 6–7 months, while spike-specific antibody responses were more durable. Seroprevalence in 559 asymptomatic patients was 1.4%. Many patients can be managed on an outpatient basis aided by risk stratification with age, sex, and NEWS2 score. Factors associated with adverse outcomes include older age, male sex, greater BMI, and a higher NEWS2 score. |
| Keywords: | clinical research / practice health services and outcomes research immunosuppressant infection and infectious agents - viral infectious disease kidney (allograft) function / dysfunction organ transplantation in general patient characteristics patient survival |