COVID-19 in solid organ transplant recipients: clinical presentation, outcome and reinfection. Multicenter study in Argentina
Natalia R Pujato1, Astrid Smud2, Laura Barcán2, Patricia Giorgio5, Melisa Martinez3, Sergio Andino4, Claudia Salgueira6,7, Rocío Gago9, Roxana Del Grosso2,8, Martin Ajzenszlos10, Lucia Cornet1, Elena Temporiti11.
1Infectious Diseases, ITAC Diaverum, Caba, Argentina; 2Infectious Diseases, HIBA, Caba, Argentina; 3Infectious Diseases, Central Hospital, Mendoza, Argentina; 4Infectious Diseases, Favaloro Foundation, Caba, Argentina; 5Infectious Diseases, Hospital Británico, Caba, Argentina; 6Infectious Diseases, Sanatorio Anchorena, Caba, Argentina; 7Infectious Diseases, Sanatorio Mitre, Caba, Argentina; 8Infectious Diseases, Sanatorio Sagrado Corazón, Caba, Argentina; 9Infectious Diseases, Hospital Austral, Pilar, Prov Buenos Aires, Argentina; 10Infectious Diseases, Hospital Argerich, Caba, Argentina; 11Infectious Diseases, CEMIC, Caba, Argentina
Introduction: COVID-19 outcome in solid organ transplant recipients (SOT) is associated with increased morbimortality compared to general population due to associated comorbidities. Infection in the early post-transplant period, nosocomial and lung transplantation would be factors associated with higher mortality.
Objective: Analyze the presentation, outcome, mortality, vaccination status and reinfection in SOT with COVID-19.
Methods: Prospective observational study, in 12 transplant centers (2020-21).
Statistical analysis: continuous variables: (mean or median) and dispersion (standard deviation or interquartile range), categorical variables: Chi-square or Fisher and Student'sT or Mann WhitneyU (continuous variables).FR of COVID-19: multiple logistic regression. Kaplan-Meier curves. Statistical significance level of 95% will be considered. All tests will be two-tailed. SPSS 13.0.2004 software (SPSS, Inc., Chicago, IL, USA) will be used.
Results: 284 episodes of COVID-19 confirmed by PCR were enrolled. 59.2% male, median age 53 (IIQ42-64). Kidney transplant 67.4%, liver 14.2%, heart 7.4%; others 10.9%. 91% presented comorbidities; 24% 1, 30% 2; 23% 3 and 14% ≥4, chronic kidney disease (71%) Hypertension (56%), diabetes (28.9%) were the most frequent. Median from transplant to episode was 52 months (IIQ13.52-103.82); 21% in the first year post-transplant. Prednisone, mycophenolate and tacrolimus were the most frequent immunosuppression(IS). COVID-19 was mild in 32%; 34.4% moderate, 28.8% severe and 4.8% asymptomatic; 66.8% was community acquisition. Fever was present in 66.5%, cough 48.6%, gastrointestinal symptoms(GS) 36.3%, myalgias 29.7% and dyspnea 29.5%. Initial management: 81.5% general ward, 11% intensive care units(ICU) and 7.5% outpatient. IS remained at 24.6%, mycophenolate was discontinued at 24.6%. 38.5% required ICU, and the risk factors (RFs) were: ≥ 4 comorbidities, increased age and time to transplant, dyspnea, high CURB-65, low PAFIO2, tachypnea, low hemoglobin, leukopenia, creatinine/ERS/CRP/ LDH and D- elevated dimer (all p<0.05). Overall mortality was 22.5%, and RFs: age >65 years, male sex, initial dyspnea, tachypnea, increased CURB-65/troponin/procalcitonin and ferritin (all p<0.05). 29% presented graft dysfunction and 2.5% graft loss; associated with case severity and decreased baseline renal function. 83.2% were discharged at 60 days. During follow-up, immunization status was evaluated in 245/284 cases (86.2%); 21(7.39%) had received 1 dose prior to the first episode . There were 18 reinfections (7.3%), 1 severe and the others mild. 11/18 had received the 3rd dose; and 3 none.
Conclusions: Higher incidence of GS than general population. Presence of multiple comorbidities, which correlates with ICU requirement. Graft dysfunction/loss in 30.4%. Overall mortality 22.2%. Immunization higher than 70% and reinfection at 7%,most mild.
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