Open AccessRisk factors for unfavorable outcome and impact of early post-transplant infection in solid organ recipients with COVID-19: A prospective multicenter cohort study
Author(s) -
Sonsoles SaltoAlejandre,
Silvia Jiménez-Jorge,
Núria Sabé,
Antonio RamosMartínez,
Laura Linares,
Maricela Valerio,
Pilar Martín-Dávila,
Mario FernándezRuiz,
María Carmen Fariñas,
Rosa Blanes,
Elisa Vidal,
Zaira R. PalaciosBaena,
Roman Hernández-Gallego,
Jordi Carratalà,
Jorge CalderónParra,
María Ángeles Marcos,
Patricia Muñóz,
Jesús Fortún-Abete,
José María Aguado,
Francisco Arnaiz-Revillas,
Rosa Blanes-Hernández,
J Torre-Cisneros,
Luis Eduardo López-Cortés,
Elena García de Vinuesa-Calvo,
Clara Rosso-Fernández,
Jerónimo Pachón,
Javier SánchezCéspedes,
Elisa Cordero
Publication year - 2021
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0250796
Subject(s) - medicine , intensive care unit , hydroxychloroquine , prospective cohort study , pneumonia , transplantation , intensive care medicine , cohort study , cohort , organ transplantation , lopinavir , disease , covid-19 , infectious disease (medical specialty)
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.