Outcomes of critically ill solid organ transplant patients with COVID-19 in the United States

Miklos Z Molnar; Anshul Bhalla; Ambreen Azhar; Makoto Tsujita; Manish Talwar; Vasanthi Balaraman; Amik Sodhi; Dipen Kadaria; James D Eason; Salim S Hayek; Steven G Coca; Shahzad Shaefi; Javier A Neyra; Shruti Gupta; David E Leaf; Csaba P Kovesdy; STOP-COVID Investigators

doi:10.1111/ajt.16280

Outcomes of critically ill solid organ transplant patients with COVID-19 in the United States

Am J Transplant. 2020 Nov;20(11):3061-3071. doi: 10.1111/ajt.16280. Epub 2020 Sep 15.

Authors

Miklos Z Molnar^{1

2

3}, Anshul Bhalla^{1

2}, Ambreen Azhar^{1

2}, Makoto Tsujita^{1

2}, Manish Talwar^{1

2}, Vasanthi Balaraman^{1

2}, Amik Sodhi⁴, Dipen Kadaria⁴, James D Eason^{1

2}, Salim S Hayek⁵, Steven G Coca⁶, Shahzad Shaefi⁷, Javier A Neyra⁸, Shruti Gupta⁹, David E Leaf⁹, Csaba P Kovesdy^{3

10}; STOP-COVID Investigators

Collaborators

STOP-COVID Investigators:
Carl P Walther, Samaya J Anumudu, Justin Arunthamakun, Kathleen F Kopecky, Gregory P Milligan, Peter A McCullough, Thuy-Duyen Nguyen, Shahzad Shaefi, Megan L Krajewski, Sidharth Shankar, Ameeka Pannu, Juan D Valencia, Sushrut S Waikar, Zoe A Kibbelaar, Ambarish M Athavale, Peter Hart, Shristi Upadhyay, Ishaan Vohra, Ajiboye Oyintayo, Adam Green, Jean-Sebastien Rachoin, Christa A Schorr, Lisa Shea, Daniel L Edmonston, Christopher L Mosher, Alexandre M Shehata, Zaza Cohen, Valerie Allusson, Gabriela Bambrick-Santoyo, Noor Ul Aain Bhatti, Bijal Mehta, Aquino Williams, Samantha K Brenner, Patricia Walters, Ronaldo C Go, Keith M Rose, Miguel A Hernán, Rebecca Lisk, Amy M Zhou, Ethan C Kim, Lili Chan, Kusum S Mathews, Steven G Coca, Deena R Altman, Aparna Saha, Howard Soh, Huei Hsun Wen, Sonali Bose, Emily A Leven, Jing G Wang, Gohar Mosoyan, Girish N Nadkarni, Pattharawin Pattharanitima, Emily J Gallagher, Allon N Friedman, John Guirguis, Rajat Kapoor, Christopher Meshberger, Katherine J Kelly, Chirag R Parikh, Brian T Garibaldi, Celia P Corona-Villalobos, Yumeng Wen, Steven Menez, Rubab F Malik, Carmen Elena Cervantes, Samir C Gautam, Mary C Mallappallil, Jie Ouyang, Sabu John, Ernie Yap, Yohannes Melaku, Ibrahim Mohamed, Siddhartha Bajracharya, Isha Puri, Mariah Thaxton, Jyotsna Bhattacharya, John Wagner, Leon Boudourakis, H Bryant Nguyen, Afshin Ahoubim, Kianoush Kashani, Shahrzad Tehranian, Leslie F Thomas, Dheeraj Reddy Sirganagari, Pramod K Guru, Yan Zhou, Paul A Bergl, Jesus Rodriguez, Jatan A Shah, Mrigank S Gupta, Princy N Kumar, Deepa G Lazarous, Seble G Kassaye, Michal L Melamed, Tanya S Johns, Ryan Mocerino, Kalyan Prudhvi, Denzel Zhu, Rebecca V Levy, Yorg Azzi, Molly Fisher, Milagros Yunes, Kaltrina Sedaliu, Ladan Golestaneh, Maureen Brogan, Neelja Kumar, Michael Chang, Jyotsana Thakkar, Ritesh Raichoudhury, Akshay Athreya, Mohamed Farag, Edward J Schenck, Soo Jung Cho, Maria Plataki, Sergio L Alvarez-Mulett, Luis G Gomez-Escobar, Di Pan, Stefi Lee, Jamuna Krishnan, William Whalen, David Charytan, Ashley Macina, Sobaata Chaudhry, Benjamin Wu, Frank Modersitzki, Anand Srivastava, Alexander Leidner, Carlos Martinez, Jacqueline M Kruser, Richard G Wunderink, Alexander J Hodakowski, Juan Carlos Q Velez, Eboni G Price-Haywood, Luis A Matute-Trochez, Anna E Hasty, Muner Mb Mohamed, Rupali S Avasare, David Zonies, David E Leaf, Shruti Gupta, Meghan E Sise, Erik T Newman, Samah Abu Omar, Kapil K Pokharel, Shreyak Sharma, Harkarandeep Singh, Simon Correa, Tanveer Shaukat, Omer Kamal, Wei Wang, Heather Yang, Jeffery O Boateng, Meghan Lee, Ian A Strohbehn, Jiahua Li, Ariel L Mueller, Roberta E Redfern, Nicholas S Cairl, Gabriel Naimy, Abeer Abu-Saif, Danyell Hall, Laura Bickley, Chris Rowan, Farah Madhani-Lovely, Vasil Peev, Jochen Reiser, John J Byun, Andrew Vissing, Esha M Kapania, Zoe Post, Nilam P Patel, Joy-Marie Hermes, Anne K Sutherland, Amee Patrawalla, Diana G Finkel, Barbara A Danek, Sowminya Arikapudi, Jeffrey M Paer, Peter Cangialosi, Mark Liotta, Jared Radbel, Sonika Puri, Jag Sunderram, Matthew T Scharf, Ayesha Ahmed, Ilya Berim, Jayanth S Vatson, Shuchi Anand, Joseph E Levitt, Pablo Garcia, Suzanne M Boyle, Rui Song, Ali Arif, Jingjing Zhang, Sang Hoon Woo, Xiaoying Deng, Goni Katz-Greenberg, Katharine Senter, Moh'd A Sharshir, Vadym V Rusnak, Muhammad Imran Ali, Terri Peters, Kathy Hughes, Anip Bansal, Amber S Podoll, Michel Chonchol, Sunita Sharma, Ellen L Burnham, David J Douin, Arash Rashidi, Rana Hejal, Eric Judd, Laura Latta, Ashita Tolwani, Timothy E Albertson, Jason Y Adams, Steven Y Chang, Rebecca M Beutler, Carl E Schulze, Etienne Macedo, Harin Rhee, Kathleen D Liu, Vasantha K Jotwani, Jay L Koyner, Chintan V Shah, Vishal Jaikaransingh, Stephanie M Toth-Manikowski, Min J Joo, James P Lash, Javier A Neyra, Nourhan Chaaban, Madona Elias, Yahya Ahmad, Alfredo Iardino, Elizabeth H Au, Jill H Sharma, Marie Anne Sosa, Sabrina Taldone, Gabriel Contreras, David De La Zerda, Alessia Fornoni, Hayley B Gershengorn, Salim S Hayek, Pennelope Blakely, Hanna Berlin, Tariq U Azam, Husam Shadid, Michael Pan, Patrick O' Hayer, Chelsea Meloche, Rafey Feroze, Kishan J Padalia, Abbas Bitar, Jeff Leya, John P Donnelly, Andrew J Admon, Jennifer E Flythe, Matthew J Tugman, Emily H Chang, Brent R Brown, Amanda K Leonberg-Yoo, Ryan C Spiardi, Todd A Miano, Meaghan S Roche, Charles R Vasquez, Amar D Bansal, Natalie C Ernecoff, Sanjana Kapoor, Siddharth Verma, Huiwen Chen, Csaba P Kovesdy, Miklos Z Molnar, Ambreen Azhar, S Susan Hedayati, Mridula V Nadamuni, Shani Shastri, Duwayne L Willett, Samuel A P Short, Amanda D Renaghan, Kyle B Enfield, Pavan K Bhatraju, A Bilal Malik, Matthew W Semler, Anitha Vijayan, Christina Mariyam Joy, Tingting Li, Seth Goldberg, Patricia F Kao, Greg L Schumaker, Nitender Goyal, Anthony J Faugno, Caroline M Hsu, Asma Tariq, Leah Meyer, Ravi K Kshirsagar, Aju Jose, Daniel E Weiner, Marta Christov, Jennifer Griffiths, Sanjeev Gupta, Aromma Kapoor, Perry Wilson, Tanima Arora, Ugochukwu Ugwuowo

Affiliations

¹ James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA.
² Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
³ Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁴ Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁵ Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.
⁶ Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁷ Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
⁸ Division of Nephrology, Bone and Mineral Metabolism, Department of Medicine, University of Kentucky, Lexington, Kentucky, USA.
⁹ Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
¹⁰ Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee, USA.

Abstract

National data on patient characteristics, treatment, and outcomes of critically ill coronavirus disease 2019 (COVID-19) solid organ transplant (SOT) patients are limited. We analyzed data from a multicenter cohort study of adults with laboratory-confirmed COVID-19 admitted to intensive care units (ICUs) at 68 hospitals across the United States from March 4 to May 8, 2020. From 4153 patients, we created a propensity score matched cohort of 386 patients, including 98 SOT patients and 288 non-SOT patients. We used a binomial generalized linear model (log-binomial model) to examine the association of SOT status with death and other clinical outcomes. 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 requirement 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 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]). Death and organ support requirement were similar between SOT and non-SOT critically ill patients with COVID-19.

Keywords: clinical research/practice; complication: infectious; infection and infectious agents - viral; infectious disease; kidney transplantation/nephrology; organ transplantation in general; patient survival.

Publication types

Multicenter Study

MeSH terms

Aged
COVID-19 / epidemiology*
Comorbidity
Critical Illness / epidemiology
Critical Illness / therapy*
Female
Follow-Up Studies
Hospital Mortality / trends
Hospitalization / trends*
Humans
Intensive Care Units / statistics & numerical data*
Male
Middle Aged
Organ Transplantation*
Pandemics*
Risk Factors
SARS-CoV-2*
Survival Rate / trends
United States / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding