Transplant Patients in ICU at No Greater Risk of Death from COVID-19 Than Non-Transplant Patients, Analysis by UTHSC Physicians Shows

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Dr. Miklos Z. Molnar

A national multicenter study that includes a data analysis component by physicians from the University of Tennessee Health Science Center determined that patients who have undergone solid-organ transplants do not have a higher risk of death than those without transplants when admitted to an intensive care unit with a COVID-19 diagnosis.

The “Study of the Treatment and Outcomes in Critically ill Patients with COVID-19” (STOP-COVID) is an ongoing umbrella study that collected COVID-19-related data and analyzed various factors for more than 4,000 ICU patients at 68 hospitals across the country from March 4 to May 8. A group of UTHSC physicians conducted a data analysis of information from the study regarding 386 patients, including 98 solid-organ transplant patients compared with 288 non-transplant patients with very similar characteristics. Their analysis shows death within 28 days of ICU admission was similar for solid-organ transplant patients as for those without transplants (40 percent and 43 percent, respectively), when both sets of patients had similar age, gender, race, and comorbidities, including hypertension, diabetes, and obesity. The study is unique as this is the first study using a well-matched control group that was able to identify whether being a transplant patient, rather than age and comorbidities, contributes to the high mortality risk that was reported previously in transplant recipients with COVID-19 infection.

The UTHSC study titled, “Outcomes of Critically Ill Solid Organ Transplant Patients with COVID 19 in the United States,” one of the few focusing on transplant patients and COVID-19, included 67 kidney, 13 liver, 13 heart, one pancreas, and four lung transplant recipients. It is significant because many transplant programs across the country have suspended their work during the pandemic under the assumption that immunosuppressed solid-organ recipients with COVID-19 would be at higher risk of death, said Miklos Z. Molnar, MD, PhD, FEBTM, FERA, FASN, associate professor of Medicine at UTHSC, transplant nephrologist at the James D. Eason Transplant Institute at Methodist University Hospital, and director of the Transplant Nephrology Fellowship program at UTHSC. Additionally, transplant patients may have heightened fear over the virus as a result of being immunocompromised, he said.

“Being a transplant patient is not going to add additional risk for worse ICU outcomes,” said Dr. Molnar, the first and corresponding author for the transplant study, which is published online in the prestigious American Journal of Transplantation. “This data should be reassuring for the transplant community.”

Other outcomes, including need for mechanical ventilation, and development of acute respiratory distress syndrome, new infection, new thrombotic events, or length of ICU stay, were also similar among both transplant recipients and those without transplants. There was, however, evidence of increased risk for acute kidney injury requiring dialysis among transplant patients.

“Risk (of death) is very high because these patients had other comorbidities, but not high because they are transplant recipients,” Dr. Molnar said. “And in this (transplant) community, this is really important because a transplant patient who is otherwise healthy can say ‘my risk of dying in the ICU with COVID-19 is not higher than any other person.’  And this is what this study is about.”