Delayed Mortality Due to COVID-19 Among Recipients of Solid Organ Transplant

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Researchers conducted a study to assess outcomes of mortality associated with COVID-19 infection among patients who previously underwent solid organ transplantation.

Among patients hospitalized with COVID-19 infection who previously underwent solid organ transplantation (SOT), more than 20% of deaths occurred between 28 and 90 days following their diagnosis, according to results of a study published in Clinical Infectious Diseases.

Researchers used data from a multicenter registry to investigate outcomes of 90-day mortality among patients hospitalized with COVID-19 infection who previously underwent SOT. Although previous studies have investigated outcomes of 1-month mortality following diagnosis with COVID-19 infection, few have examined the relationship between delayed mortality and COVID-19 infection in SOT recipients. The researchers used multivariable Cox proportional regression models to assess risk factors associated with mortality between days 28 and 90 after the initial onset of COVID-19 infection.

Among a total of 1117 patients included in the final analysis, vital status at day 90 was available for 936 (84%). Of these patients, 190 (20%) died within 28 days and 56 (23%) died between days 29 and 90. The mean patient age was 59 (IQR, 49-67) years, 62% were men, and 34% had undergone SOT within the past 2 years.

Mortality after 90 days was associated with older age (>65 years; adjusted hazard ratio [aHR], 1.8; 95% CI, 1.3-2.4; P <.001), prior lung transplant (aHR, 1.5; 95% CI, 1.0-2.3; P =.05), heart failure (aHR, 1.9; 95% CI, 1.2-2.9; P =.006), chronic lung disease (aHR, 2.3; 95% CI, 1.5-3.6; P <.001), and increased BMI (≥30 kg/m2; aHR, 1.5; 95% CI, 1.1-2.0; P =.02). Similar associations were observed for mortality within 28 days.

Compared with patients diagnosed with COVID-19 infection between March and June 20, 2020, those who received a diagnosis between June 20 and December 2020 had a decreased rate of mortality after 28 days (aHR, 0.7; 95% CI, 0.5-1.0; P =.04) but not after 90 days (aHR 0.9, 95% CI 0.7-1.3; P =.61).

Study limitations included that among patients who survived after 28 days, 20% were lost to follow-up. In addition, this study was conducted before COVID-19 vaccines became available and specific data on management strategies and indications for hospitalization were not collected.

According to the researchers, “future investigations focusing on COVID-19 mortality should consider extending follow-up duration to 90 days for more accurate capture of mortality and associated risk factors.”

Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. 


Heldman MR, Kates OS, Safa K, et al. Delayed mortality among solid organ transplant recipients hospitalized for COVID-19. Clin Infect Dis. Published online February 25, 2022. doi:10.1093/cid/ciac159