Abstract
While older males are at the highest risk for poor coronavirus disease 2019 (COVID-19) outcomes, it is not known if this applies to the immunosuppressed recipient of a solid organ transplant (SOT), nor how the type of allograft transplanted may impact outcomes. In a cohort study of adult (>18 years) patients testing positive for COVID-19 (January 1, 2020-June 21, 2021) from 56 sites across the United States identified using the National COVID Cohort Collaborative (N3C) Enclave, we used multivariable Cox proportional hazards models to assess time to MARCE after COVID-19 diagnosis in those with and without SOT. We examined the exposure of age-stratified recipient sex overall and separately in kidney, liver, lung, and heart transplant recipients. 3996 (36.4%) SOT and 91 646 (4.8%) non-SOT patients developed MARCE. Risk of post-COVID outcomes differed by transplant allograft type with heart and kidney recipients at highest risk. Males with SOT were at increased risk of MARCE, but to a lesser degree than the non-SOT cohort (HR 0.89, 95% CI 0.81–0.98 for SOT and HR 0.61, 95% CI 0.60–0.62 for non-SOT [females vs. males]). This represents the largest COVID-19 SOT cohort to date and the first-time sex-age–stratified and allograft-specific COVID-19 outcomes have been explored in those with SOT.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 245-259 |
| Number of pages | 15 |
| Journal | American Journal of Transplantation |
| Volume | 22 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2022 |
ASJC Scopus subject areas
- Immunology and Allergy
- Transplantation
- Pharmacology (medical)
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In: American Journal of Transplantation, Vol. 22, No. 1, 01.2022, p. 245-259.
Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Sex and organ-specific risk of major adverse renal or cardiac events in solid organ transplant recipients with COVID-19
AU - National COVID Cohort Collaborative (N3C) Consortium
AU - Vinson, Amanda J.
AU - Dai, Ran
AU - Agarwal, Gaurav
AU - Anzalone, Alfred J.
AU - Lee, Stephen B
AU - French, Evan
AU - Olex, Amy L.
AU - Madhira, Vithal
AU - Mannon, Roslyn B
AU - Islam, Jessica Y.
AU - Patch, David A.
AU - Gabriel, Davera
AU - Sun, Jing
AU - Singh, Namrata
AU - Chute, Christopher G.
AU - Duong, Tim Q.
AU - Haendel, Melissa
N1 - Funding Information: National Institute of Health’s (NIH) National COVID Cohort Collaborative (N3C) Data Utilization Request Approval committee approved the data utilization request of this project (RP-CA3365). Each author’s home institution executed Data Use Agreements for participation in N3C. All research team members relied upon Data Use Agreements executed between their home institutions and National Center for Advancing Translational Sciences (NCATS) for access to N3C. Our study protocol was approved by the N3C Data Access Committee prior to analysis. NACTS reviewed all data elements prior to extraction. The N3C data transfer to NCATS is performed under a Johns Hopkins University Reliance Protocol # IRB00249128 or individual site agreements with NIH. The N3C Data Enclave is managed under the authority of the NIH; information can be found at https://ncats.nih.gov/n3c/resources. AO and EF were supported by CTSA award No. UL1TR002649 from the National Center for Advancing Translational Sciences. The analyses described in this publication were conducted with data or tools accessed through the NCATS N3C Data Enclave https://covid.cd2h.org and N3C Attribution and Publication Policy v 1.2-2020-08-25b supported by NCATS U24 TR002306 and by the National Institute of General Medical Sciences, U54 GM115458, which funds the Great Plains IDeA-CTR Network. RBM is supported by BMX003272 and the Dr. Dennis Ross Research Fund in Nephrology, University of Nebraska. Funding Information: National Institute of Health’s (NIH) National COVID Cohort Collaborative (N3C) Data Utilization Request Approval committee approved the data utilization request of this project (RP‐CA3365). Each author’s home institution executed Data Use Agreements for participation in N3C. All research team members relied upon Data Use Agreements executed between their home institutions and National Center for Advancing Translational Sciences (NCATS) for access to N3C. Our study protocol was approved by the N3C Data Access Committee prior to analysis. NACTS reviewed all data elements prior to extraction. The N3C data transfer to NCATS is performed under a Johns Hopkins University Reliance Protocol # IRB00249128 or individual site agreements with NIH. The N3C Data Enclave is managed under the authority of the NIH; information can be found at https://ncats.nih.gov/n3c/resources . AO and EF were supported by CTSA award No. UL1TR002649 from the National Center for Advancing Translational Sciences. The analyses described in this publication were conducted with data or tools accessed through the NCATS N3C Data Enclave https://covid.cd2h.org and N3C Attribution and Publication Policy v 1.2‐2020‐08‐25b supported by NCATS U24 TR002306 and by the National Institute of General Medical Sciences, U54 GM115458, which funds the Great Plains IDeA‐CTR Network. RBM is supported by BMX003272 and the Dr. Dennis Ross Research Fund in Nephrology, University of Nebraska. Funding Information: The authors of this manuscript have conflicts of interest to disclose as described by the . AV has done consultancy work and received funding for a fellowship project grant through Paladin Labs Inc. AG has received educational funds from Mallinckrodt Pharmaceuticals and has served as PI for studies by Mallinckrodt Pharmaceuticals and CSL Behring. RBM reports personal fees from Vitaerris as member of the IMAGINE Trial Steering committee, and personal fees from as Deputy Editor of the journal, outside the submitted work. American Journal of Transplantation American Journal of Transplantation Funding Information: Data partners with released data: Stony Brook University—U24TR002306. University of Oklahoma Health Sciences Center—U54GM104938: Oklahoma Clinical and Translational Science Institute (OCTSI). West Virginia University—U54GM104942: West Virginia Clinical and Translational Science Institute (WVCTSI). University of Mississippi Medical Center—U54GM115428: Mississippi Center for Clinical and Translational Research (CCTR). University of Nebraska Medical Center—U54GM115458: Great Plains IDeA‐Clinical & Translational Research. Maine Medical Center—U54GM115516: Northern New England Clinical & Translational Research (NNE‐CTR) Network. Wake Forest University Health Sciences—UL1TR001420: Wake Forest Clinical and Translational Science Institute. Northwestern University at Chicago—UL1TR001422: Northwestern University Clinical and Translational Science Institute (NUCATS). University of Cincinnati—UL1TR001425: Center for Clinical and Translational Science and Training. The University of Texas Medical Branch at Galveston—UL1TR001439: The Institute for Translational Sciences. Medical University of South Carolina—UL1TR001450: South Carolina Clinical & Translational Research Institute (SCTR). University of Massachusetts Medical School Worcester—UL1TR001453: The UMass Center for Clinical and Translational Science (UMCCTS). University of Southern California—UL1TR001855: The Southern California Clinical and Translational Science Institute (SC CTSI). Columbia University Irving Medical Center—UL1TR001873: Irving Institute for Clinical and Translational Research. George Washington Children's Research Institute—UL1TR001876: Clinical and Translational Science Institute at Children's National (CTSA‐CN). University of Kentucky—UL1TR001998: UK Center for Clinical and Translational Science. University of Rochester—UL1TR002001: UR Clinical & Translational Science Institute. University of Illinois at Chicago—UL1TR002003: UIC Center for Clinical and Translational Science. Penn State Health Milton S. Hershey Medical Center—UL1TR002014: Penn State Clinical and Translational Science Institute. The University of Michigan at Ann Arbor—UL1TR002240: Michigan Institute for Clinical and Health Research. Vanderbilt University Medical Center—UL1TR002243: Vanderbilt Institute for Clinical and Translational Research. University of Washington—UL1TR002319: Institute of Translational Health Sciences. Washington University in St. Louis—UL1TR002345: Institute of Clinical and Translational Sciences. Oregon Health & Science University—UL1TR002369: Oregon Clinical and Translational Research Institute. University of Wisconsin‐Madison—UL1TR002373: UW Institute for Clinical and Translational Research. Rush University Medical Center—UL1TR002389: The Institute for Translational Medicine (ITM). The University of Chicago—UL1TR002389: The Institute for Translational Medicine (ITM). University of North Carolina at Chapel Hill—UL1TR002489: North Carolina Translational and Clinical Science Institute. University of Minnesota—UL1TR002494: Clinical and Translational Science Institute. Children's Hospital Colorado—UL1TR002535: Colorado Clinical and Translational Sciences Institute. The University of Iowa—UL1TR002537: Institute for Clinical and Translational Science. The University of Utah—UL1TR002538: Uhealth Center for Clinical and Translational Science. Tufts Medical Center—UL1TR002544: Tufts Clinical and Translational Science Institute. Duke University—UL1TR002553: Duke Clinical and Translational Science Institute. Virginia Commonwealth University—UL1TR002649: C. Kenneth and Dianne Wright Center for Clinical and Translational Research. The Ohio State University—UL1TR002733: Center for Clinical and Translational Science. The University of Miami Leonard M. Miller School of Medicine—UL1TR002736: University of Miami Clinical and Translational Science Institute. University of Virginia—UL1TR003015: iTHRIV Integrated Translational health Research Institute of Virginia. Carilion Clinic—UL1TR003015: iTHRIV Integrated Translational health Research Institute of Virginia. University of Alabama at Birmingham—UL1TR003096: Center for Clinical and Translational Science. Johns Hopkins University—UL1TR003098: Johns Hopkins Institute for Clinical and Translational Research. University of Arkansas for Medical Sciences—UL1TR003107: UAMS Translational Research Institute. Nemours—U54GM104941: Delaware CTR ACCEL Program. University Medical Center New Orleans—U54GM104940: Louisiana Clinical and Translational Science (LA CaTS) Center. University of Colorado Denver, Anschutz Medical Campus—UL1TR002535: Colorado Clinical and Translational Sciences Institute. Mayo Clinic Rochester—UL1TR002377: Mayo Clinic Center for Clinical and Translational Science (CCaTS). Tulane University—UL1TR003096: Center for Clinical and Translational Science. Loyola University Medical Center—UL1TR002389: The Institute for Translational Medicine (ITM). Advocate Health Care Network—UL1TR002389: The Institute for Translational Medicine (ITM). OCHIN—INV‐018455: Bill and Melinda Gates Foundation grant to Sage Bionetworks. Publisher Copyright: © 2021 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2022/1
Y1 - 2022/1
N2 - While older males are at the highest risk for poor coronavirus disease 2019 (COVID-19) outcomes, it is not known if this applies to the immunosuppressed recipient of a solid organ transplant (SOT), nor how the type of allograft transplanted may impact outcomes. In a cohort study of adult (>18 years) patients testing positive for COVID-19 (January 1, 2020-June 21, 2021) from 56 sites across the United States identified using the National COVID Cohort Collaborative (N3C) Enclave, we used multivariable Cox proportional hazards models to assess time to MARCE after COVID-19 diagnosis in those with and without SOT. We examined the exposure of age-stratified recipient sex overall and separately in kidney, liver, lung, and heart transplant recipients. 3996 (36.4%) SOT and 91 646 (4.8%) non-SOT patients developed MARCE. Risk of post-COVID outcomes differed by transplant allograft type with heart and kidney recipients at highest risk. Males with SOT were at increased risk of MARCE, but to a lesser degree than the non-SOT cohort (HR 0.89, 95% CI 0.81–0.98 for SOT and HR 0.61, 95% CI 0.60–0.62 for non-SOT [females vs. males]). This represents the largest COVID-19 SOT cohort to date and the first-time sex-age–stratified and allograft-specific COVID-19 outcomes have been explored in those with SOT.
AB - While older males are at the highest risk for poor coronavirus disease 2019 (COVID-19) outcomes, it is not known if this applies to the immunosuppressed recipient of a solid organ transplant (SOT), nor how the type of allograft transplanted may impact outcomes. In a cohort study of adult (>18 years) patients testing positive for COVID-19 (January 1, 2020-June 21, 2021) from 56 sites across the United States identified using the National COVID Cohort Collaborative (N3C) Enclave, we used multivariable Cox proportional hazards models to assess time to MARCE after COVID-19 diagnosis in those with and without SOT. We examined the exposure of age-stratified recipient sex overall and separately in kidney, liver, lung, and heart transplant recipients. 3996 (36.4%) SOT and 91 646 (4.8%) non-SOT patients developed MARCE. Risk of post-COVID outcomes differed by transplant allograft type with heart and kidney recipients at highest risk. Males with SOT were at increased risk of MARCE, but to a lesser degree than the non-SOT cohort (HR 0.89, 95% CI 0.81–0.98 for SOT and HR 0.61, 95% CI 0.60–0.62 for non-SOT [females vs. males]). This represents the largest COVID-19 SOT cohort to date and the first-time sex-age–stratified and allograft-specific COVID-19 outcomes have been explored in those with SOT.
UR - http://www.scopus.com/inward/record.url?scp=85122135072&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85122135072&partnerID=8YFLogxK
U2 - 10.1111/ajt.16865
DO - 10.1111/ajt.16865
M3 - Article
C2 - 34637599
AN - SCOPUS:85122135072
SN - 1600-6135
VL - 22
SP - 245
EP - 259
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 1
ER -