Simple Summary It is still uncertain whether recipients of solid organ transplant (SOT) are at increased risk of SARS-CoV-2 infection and/or poor outcomes due to COVID-19 in comparison to the general population. In this study, we report the cumulative incidence and outcomes of SARS-CoV-2 infection in a cohort of 291 SOT recipients. The COVID-19 cumulative incidence in SOT recipients resulted slightly higher compared to that of age-matched population during the study period. Moreover, the SARS-CoV-2 antibody frequency was around 2.6-fold higher than the incidence of cases who tested positive for SARS-CoV-2 RT-PCR, suggesting that the number of SOT recipients infected with SARS-CoV-2 is likely higher than described. In symptomatic recipients, kidney transplant was associated with a higher risk of developing moderate/critical disease, while common risk factors, including age and comorbidities, resulted less relevant for COVID-19 severity. Due to the high estimated crude mortality, symptomatic SOT recipients should be considered at high risk in case of SARS-CoV-2 infection. Abstract Background: Solid organ transplant (SOT) recipients may be at increased risk for severe disease and mortality from COVID-19 because of immunosuppression and prolonged end-stage organ disease. As a transplant center serving a diverse patient population, we report the cumulative incidence and outcomes of SARS-CoV-2 infection in our cohort of SOT recipients. Methods: We prospectively included in this observational study SOT recipients with a functioning kidney ( n = 201), pancreas ± kidney ( n = 66) or islet transplant ( n = 24), attending outpatient regular follow-up at the San Raffaele Hospital from February 2020 to April 2021. Antibodies to SARS-CoV-2 were tested in all patients by a luciferase immunoprecipitation system assay. Results: Of the 291 SOT recipients, 30 (10.3%) tested positive for SARS-CoV-2 during the study period and prevalence was not different among different transplants. The SARS-CoV-2 antibody frequency was around 2.6-fold higher than the incidence of cases who tested positive for SARS-CoV-2 RT-PCR. As for the WHO COVID-19 severity classification, 19 (63.3%) SOT recipients were mild, nine (30%) were moderate, and two were critical and died yielding a crude mortality rate in our patient population of 6.7%. Kidney transplant (OR 12.9 (1.1–150) p = 0.041) was associated with an increased risk for moderate/critical disease, while statin therapy (OR 0.116 (0.015–0.926) p = 0.042) and pancreas/islet transplant (OR 0.077 (0.007–0.906) p = 0.041) were protective. Conclusions: The incidence of SARS-CoV-2 infection in SOT recipients may be higher than previously described. Due to the relative high crude mortality, symptomatic SOT recipients must be considered at high risk in case of SARS-CoV-2 infection.
【저자키워드】 COVID-19, SARS-CoV-2, Seroprevalence, pancreas transplantation, islet transplantation, 【초록키워드】 therapy, Risk factors, Mortality, antibody, SARS-COV-2 infection, Comorbidities, COVID-19 severity, Immunosuppression, outcome, kidney, Prevalence, Cohort, SARS-CoV-2 antibody, symptomatic, Patient, Mild, age, Follow-up, General population, mortality rate, SARS-CoV-2 RT-PCR, incidence, disease, Critical, moderate, kidney transplant, solid organ transplant, Protective, islet, Frequency, severe disease, solid organ, SOT, high risk, Luciferase immunoprecipitation system, higher risk, increased risk, recipients, study period, cumulative, positive, recipient, organ, patient population, San Raffaele Hospital, transplants, simple, tested, described, died, nine, less, the WHO, not different, infected with SARS-CoV-2, pancrea, the SARS-CoV-2, yielding, 【제목키워드】 Transplant, Factor, Solid,