LAUSR

BACKGROUND Organ transplant recipients comprise an immunocompromised and vulnerable cohort. Outcomes of COVID-19 in solid organ transplant (SOT) recipients remain understudied. METHODS We used a multicenter federated research network to compare clinical outcomes of COVID-19 in patients with SOT to a propensity matched cohort of patients without SOT. RESULTS We identified 2,307 SOT recipients and 231,047 non-transplant patients with COVID-19. Transplant patients were more likely to be male, older, have a BMI >30kg/m2, and have comorbid hypertension, diabetes, nicotine dependence, heart failure and ischemic heart disease compared to non-transplant group (p-value <0.05). 1:1 matching was performed for diabetes, hypertension, chronic lung diseases, race, nicotine dependence, heart failure, ischemic heart disease and gender. There was no difference in the composite outcome of intubation or mechanical ventilation at 30 days (RR 1.04, 95% CI: 0.86-1.26) or 60 days (RR 1.03, 95% CI: 0.86-1.24) between the two groups. Hospitalization rate was higher in the transplant cohort (30.97% vs 25.47%, RR 1.22, 95% CI: 1.11-1.34). There was no difference in mortality at 30 days (6.45% vs 5.29%, RR 1.22, 95% CI: 0.88-1.68) or 60 days post diagnosis (RR 1.05, 95% CI: 0.83-1.32). More patients in the SOT group developed acute renal injury compared to non-SOT cohort (24.73% vs 14.29%; RR 1.73, 95% CI: 1.53-1.96). CONCLUSION Patients with SOT have high COVID-19 related mortality, however propensity matched analyses reveal that this increased risk is secondary to higher burden of comorbidities. SOT status independently increases risk of hospital admission and acute kidney injury.