Clinical Features of SARS-CoV-2 Infection in Patients Undergoing Solid-Organ Transplant: Baskent University Experience

Respiratory Multiplex Polymerase Chain Reaction Could Predict Morbidity and Mortality in Solid-Organ Transplant Patients: Başkent University Experience

OBJECTIVES

Respiratory tract infections are commonly seen and compose a great burden on health care. The causing pathogens might be either bacteria or viruses. Because treatment is different for each, prompt diagnosis and early treatment are crucial, especially in immunocompromised patients like solid-organ transplant recipients who often present with obscure findings. The aim of this study was to compare the respiratory multiplex polymerase chain reaction results of solid-organ transplant recipients with results of other hospitalized patients (control group) and to analyze whether results played a role in morbidity and mortality prediction.

MATERIALS AND METHODS

The study was approved by the ethical committee of Başkent University (KA23/233) and included all patients who were hospitalized from January 1, 2023, to December 31, 2023, and who underwent multiplex polymerase chain reaction for diagnosis of respiratory tract infection.

RESULTS

Among analyses of 192 polymerase chain reaction samples performed in 177 patients (45 solid-organ transplant patients and 132 controls), no differences in frequency or pathogen type were shown between the groups. A positive result was associated with increased mortality in transplant patients but not in controls. Kaplan-Meier survival analysis showed no difference for survival time within 6 months of follow-up between the groups. Logistic regression analysis showed an increase of 4.28-fold in mortality for transplant patients if a positive polymerase chain reaction result was present.

CONCLUSIONS

Respiratory multiplex polymerase chain reaction is a tool for fast diagnosis and prompt initiation of the right treatment. A positive result in transplant patients was associated with increased mortality.

Comparison of COVID-19 Hospitalization and Death Between Solid Organ Transplant Recipients and the General Population in Canada, 2020-2022

Background

Solid organ transplant recipients have a high risk of severe outcomes from SARS-CoV-2 infection. A comprehensive understanding of the impact of the COVID-19 pandemic across multiple waves in the solid organ transplant population and how this compares to the general population is limited. We conducted a population-based cohort study using linked administrative healthcare databases from Ontario, Canada to answer this question.

Methods

We included 15 306 solid organ transplant recipients and 12 160 904 individuals from the general population. Our primary outcome was the rate (per 100 person-years) of severe COVID-19 (ie, hospitalization or death with a positive SARS-CoV-2 test) occurring between January 25, 2020, and November 30, 2022.

Results

Compared with the general population, solid organ transplant recipients had almost a 6 times higher rate of severe COVID-19 (20.39 versus 3.44 per 100 person-years), with almost 5.5 times as high a rate of death alone (4.19 versus 0.77 per 100 person-years). Transplant recipients with severe COVID-19 were substantially younger (60.1 versus 66.5 y) and had more comorbidities. The rate of severe COVID-19 declined over time in the solid organ transplant population, with an incidence rate of 41.25 per 100 person-years in the first wave (January 25, 2020, to August 31, 2020) and 18.41 in the seventh wave (June 19, 2022, to November 30, 2022, Omicron era).

Conclusions

Solid organ transplant recipients remain at high risk of severe outcomes when they are infected with SARS-CoV-2. Resources and strategies to mitigate the impact of SARS-CoV-2 exposure are needed in this vulnerable patient population.

Clinical outcome in solid organ transplant recipients affected by COVID-19 compared to general population: a systematic review and meta-analysis

BACKGROUND

A significant increased risk of complications and mortality in immunocompromised patients affected by COVID-19 has been described. However, the impact of COVID-19 in solid organ transplant (SOT) recipients is an issue still under debate, due to conflicting evidence that has emerged from different observational studies.

OBJECTIVES

We performed a systematic review with a meta-analysis to assess the clinical outcome in SOT recipients with COVID-19 compared with the general population.

DATA SOURCES

PubMed-MEDLINE and Scopus were independently searched until 13 October 2021.

STUDY ELIGIBILITY CRITERIA

Prospective or retrospective observational studies comparing clinical outcome in SOT recipients versus general populations affected by COVID-19 were included. The primary endpoint was 30-day mortality.

PARTICIPANTS

Participants were patients with confirmed COVID-19.

INTERVENTIONS

Interventions reviewed were SOTs.

METHODS

The quality of the included studies was independently assessed with the Risk of Bias in Non-randomized Studies of Interventions tool for observational studies. The meta-analysis was performed by pooling ORs retrieved from studies providing adjustment for confounders using a random-effects model with the inverse variance method. Multiple subgroups and sensitivity analyses were conducted to investigate the source of heterogeneity.

RESULTS

A total of 3501 articles were screened, and 31 observational studies (N = 590 375; 5759 SOT recipients vs. 584 616 general population) were included in the meta-analyses. No difference in 30-day mortality rate was found in the primary analysis, including studies providing adjustment for confounders (N = 17; 3752 SOT recipients vs. 159 745 general population; OR: 1.13; 95% CI, 0.94-1.35; I2 = 33.9%). No evidence of publication bias was reported. A higher risk of intensive care unit admission (OR: 1.56; 95% CI, 1.03-2.63) and occurrence of acute kidney injury (OR: 2.50; 95% CI, 1.81-3.45) was found in SOT recipients.

CONCLUSIONS

No increased risk in mortality was found in SOT recipients affected by COVID-19 compared with the general population when adjusted for demographic and clinical features and COVID-19 severity.