Early pandemic in-hospital outcomes and mortality risk factors in COVID-19 solid organ transplant patients

Laith Alhuneafat; Muhammad Umar Khalid; Ahmad Jabri; Matthew D Deicke; Shiza Virk; Max W Jacobs; Eileen Hsich; Mohammad Alqarqaz; Mark E Dunlap; Hayah Kassis-George; Christopher Link

doi:10.1080/08998280.2024.2325310

Early pandemic in-hospital outcomes and mortality risk factors in COVID-19 solid organ transplant patients

Proc (Bayl Univ Med Cent). 2024 Mar 19;37(3):414-423. doi: 10.1080/08998280.2024.2325310. eCollection 2024.

Authors

Affiliations

¹ Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA.
² Department of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
³ Heart and Vascular Center, Henry Ford, Detroit, Michigan, USA.
⁴ Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
⁵ Advanced Heart Failure and Transplant, Cleveland Clinic, Cleveland, Ohio, USA.
⁶ Heart and Vascular Center, MetroHealth Medical Center, Cleveland, Ohio, USA.
⁷ Advanced Heart Failure and Transplant, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.

Abstract

Background: Solid organ transplant (SOT) recipients with COVID-19 have a higher risk of mortality than those without COVID-19. However, it is unclear how SOT patient outcomes compare to the general population without SOT who contract COVID-19.

Methods: We used the National Inpatient Sample from January to December 2020 to investigate inpatient outcomes seen in SOT recipients after contracting COVID-19 compared to nontransplant patients. We identified our study sample using ICD-10 CM and excluded those <18 years of age and those with dual organ transplants. Inpatient outcomes were compared in SOT and non-SOT COVID cohorts, and we further evaluated predictors of mortality in the SOT with COVID population.

Results: Out of the 1,416,445 COVID-19 admissions included in the study, 8315 (0.59%) were single SOT recipients. Our analysis that adjusted for multiple baseline characteristics and comorbidities demonstrated that COVID-19 in SOT patients was associated with higher rates of acute kidney injury (adjusted odds ratio [aOR] 2.34, 95% confidence interval [CI] 1.81-3.02, P < 0.01), lower rates of acute respiratory distress syndrome (aOR 0.68, 95% CI 0.54-0.85, P < 0.01), and similar rates of cardiac arrest, pulmonary embolism, circulatory shock, cerebrovascular events, and in-hospital mortality. Age >65 was associated with mortality in SOT patients.

Conclusion: In this nationally representative sample, SOT patients presenting with COVID-19 experienced similar rates of mortality compared to those without SOT. SOT patients were more likely to develop acute kidney injury. Further research is needed to understand the complex relationship between transplant patient outcomes and COVID-19.

Keywords: COVID-19; SARS-CoV-2; outcomes; solid organ transplantation.

Grants and funding

The HSPSO is funded by Highmark Health (Pittsburgh, PA, USA), and all work was done in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).