Prognosis of transplant recipients with COVID 19 similar to general population: Study

A recent study has suggested that Death and organ support requirements were similar between solid organ transplant (SOT) and non-SOT critically ill patients with COVID-19.

The findings of the study have been published in the American Journal of Transplantation.

Since December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread from Wuhan, China to the rest of the world, leading to more than 20 million confirmed cases of coronavirus disease 2019 (COVID-19). The spectrum of clinical disease from COVID-19 varies from a mild febrile illness to critical illness, including acute respiratory distress syndrome (ARDS) and multiorgan failure, which are associated with high morbidity and mortality.

Previously published studies focusing on SOT patients and COVID-19 lack comparison with a control group to ascertain their risk as compared to the general population.

To address this knowledge gap, Miklos Z. Molnar et al at the James D. Eason Transplant Institute, Methodist University Hospital, USA, compared outcomes in SOT versus non-SOT patients with COVID-19 who were admitted to intensive care units (ICUs) throughout the US, using data from a multicenter cohort study.

Data was assessed from the Study of the Treatment and Outcomes in critically ill Patients with COVID-19 (STOP-COVID).

Data was taken from patients with laboratory-confirmed COVID-19 admitted to intensive care units(ICUs) at 68 hospitals across the United States from March 4th to May 8 th, 2020. From 4,153 patients, researchers created a propensity score-matched cohort of 386 patients, including 98 SOT patients and 288 non-SOT patients.

The primary outcome was death within 28 days of ICU admission. They also assessed the following secondary outcomes: ICU length of stay, receipt, and duration of invasive mechanical ventilation; receipt and duration of extracorporeal membrane oxygenation, acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), thromboembolic event, including deep venous thrombosis, pulmonary embolism, stroke, or other thromboembolic events; receipt of vasopressors and the number of days on vasopressor therapy.

Findings brought forth the following key facts.

Among the 386 patients, the median age was 60 years, 72% were male, and 41% were black.

Death within 28 days of ICU admission was similar in SOT and non-SOT patients(40% and 43%, respectively; relative risk[RR] 0.92 [95% Confidence Interval(CI):0.70-1.22]).

Other outcomes and requirements for organ support including receipt of mechanical ventilation, development of acute respiratory distress syndrome, and receipt of vasopressors were also similar between groups.

There was a trend toward a higher risk of acute kidney injury requiring renal replacement therapy in SOT vs. non-SOT patients (37% vs. 27%; RR[95%CI]:1.34 [0.97-1.85]).

"To the best of our knowledge, this is the first study assessing outcomes of COVID-19 infection in SOT patients using a control group of non-transplant patients as a comparator in ICU patients." said the authors.

For the full article click on the link: https://doi.org/10.1111/ajt.16280

Primary source: American Journal of Transplantation