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

• Main Authors: Sonsoles Salto-Alejandre, Silvia Jiménez-Jorge, Nuria Sabé, Antonio Ramos-Martínez, Laura Linares, Maricela Valerio, Pilar Martín-Dávila, Mario Fernández-Ruiz, María Carmen Fariñas, Marino Blanes-Juliá, Elisa Vidal, Zaira R Palacios-Baena, Román Hernández-Gallego, Jordi Carratalá, Jorge Calderón-Parra, María Ángeles Marcos, Patricia Muñoz, Jesús Fortún-Abete, José María Aguado, Francisco Arnaiz-Revillas, Rosa Blanes-Hernández, Julián de la Torre-Cisneros, Luis E López-Cortés, Elena García de Vinuesa-Calvo, Clara M Rosso, Jerónimo Pachón, Javier Sánchez-Céspedes, Elisa Cordero, COVIDSOT Working Team
• Format: Article
• Language: English
• Published: Public Library of Science (PLoS) 2021-01-01
• Series: PLoS ONE
• Online Access: https://doi.org/10.1371/journal.pone.0250796

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.