Changing trends in mortality among solid organ transplant recipients hospitalized for COVID-19 during the course of the pandemic.
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
washington; seattle; swedish; covid-19; clinical research/practice; infection and infectious agents - viral; infectious disease; organ transplantation in general; quality of care/care delivery
Mortality among patients hospitalized for COVID-19 has declined over the course of the pandemic. Mortality trends specifically in solid organ transplant recipients (SOTR) are unknown. Using data from a multicenter registry of SOTR hospitalized for COVID-19, we compared 28-day mortality between early 2020 (March 1, 2020-June 19, 2020) and late 2020 (June 20, 2020-December 31, 2020). Multivariable logistic regression was used to assess comorbidity-adjusted mortality. Time period of diagnosis was available for 1435/1616 (88.8%) SOTR and 971/1435 (67.7%) were hospitalized: 571/753 (75.8%) in early 2020 and 402/682 (58.9%) in late 2020 (p < .001). Crude 28-day mortality decreased between the early and late periods (112/571 [19.6%] vs. 55/402 [13.7%]) and remained lower in the late period even after adjusting for baseline comorbidities (aOR 0.67, 95% CI 0.46-0.98, p = .016). Between the early and late periods, the use of corticosteroids (≥6 mg dexamethasone/day) and remdesivir increased (62/571 [10.9%] vs. 243/402 [61.5%], p < .001 and 50/571 [8.8%] vs. 213/402 [52.2%], p < .001, respectively), and the use of hydroxychloroquine and IL-6/IL-6 receptor inhibitor decreased (329/571 [60.0%] vs. 4/492 [1.0%], p < .001 and 73/571 [12.8%] vs. 5/402 [1.2%], p < .001, respectively). Mortality among SOTR hospitalized for COVID-19 declined between early and late 2020, consistent with trends reported in the general population. The mechanism(s) underlying improved survival require further study.
Heldman, Madeleine R; Kates, Olivia S; Safa, Kassem; Kotton, Camille N; Georgia, Sarah J; Steinbrink, Julie M; Alexander, Barbara D; Hemmersbach-Miller, Marion; Blumberg, Emily A; Multani, Ashrit; Haydel, Brandy; La Hoz, Ricardo M; Moni, Lisset; Condor, Yesabeli; Flores, Sandra; Munoz, Carlos G; Guitierrez, Juan; Diaz, Esther I; Diaz, Daniela; Vianna, Rodrigo; Guerra, Giselle; Loebe, Matthias; Rakita, Robert M; Malinis, Maricar; Azar, Marwan M; Hemmige, Vagish; McCort, Margaret E; Chaudhry, Zohra S; Singh, Pooja P; Hughes Kramer, Kailey; Velioglu, Arzu; Yabu, Julie M; Morillis, Jose A; Mehta, Sapna A; Tanna, Sajal D; Ison, Michael G; Derenge, Ariella C; van Duin, David; Maximin, Adrienne; Gilbert, Carlene; Goldman, Jason D; Lease, Erika D; Fisher, Cynthia E; and Limaye, Ajit P, "Changing trends in mortality among solid organ transplant recipients hospitalized for COVID-19 during the course of the pandemic." (2021). Articles, Abstracts, and Reports. 5294.