SARS-CoV-2 infection and early mortality of waitlisted and solid organ transplant recipients in England: A national cohort study

Rommel Ravanan*, Chris J. Callaghan, Lisa Mumford, Ines Ushiro-Lumb, Douglas Thorburn, John Casey, Peter Friend, Jayan Parameshwar, Ian Currie, Lisa Burnapp, Richard Baker, Jan Dudley, Gabriel C. Oniscu, Marius Berman, John Asher, Dan Harvey, Alex Manara, Derek Manas, Dale Gardiner, John L.R. Forsythe

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

50 Citations (Scopus)

Abstract

Patients waitlisted for and recipients of solid organ transplants (SOT) are perceived to have a higher risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and death; however, definitive epidemiological evidence is lacking. In a comprehensive national cohort study enabled by linkage of the UK transplant registry and Public Health England and NHS Digital Tracing services, we examined the incidence of laboratory-confirmed SARS-CoV-2 infection and subsequent mortality in patients on the active waiting list for a deceased donor SOT and recipients with a functioning SOT as of February 1, 2020 with follow-up to May 20, 2020. Univariate and multivariable techniques were used to compare differences between groups and to control for case-mix. One hundred ninety-seven (3.8%) of the 5184 waitlisted patients and 597 (1.3%) of the 46 789 SOT recipients tested positive for SARS-CoV-2. Mortality after testing positive for SARS-CoV-2 was 10.2% (20/197) for waitlisted patients and 25.8% (154/597) for SOT recipients. Increasing recipient age was the only variable independently associated with death after positive SARS-CoV-2 test. Of the 1004 transplants performed in 2020, 41 (4.1%) recipients have tested positive for SARS-CoV-2 with 8 (0.8%) deaths reported by May 20. These data provide evidence to support decisions on the risks and benefits of SOT during the coronavirus disease 2019 pandemic.

Original languageEnglish
Pages (from-to)3008-3018
Number of pages11
JournalAmerican Journal of Transplantation
Volume20
Issue number11
DOIs
Publication statusPublished - 1 Nov 2020
Externally publishedYes

Bibliographical note

Funding Information:
The authors acknowledge Public Health England and NHS Digital Tracing Service for sharing data; James Thomas, Tariq Malik, Anne Marie O'Connell (PHE) and Richard Little (NHSBT) for enabling database linkages; Olive McGowan, Karen Quinn, Julie Whitney, Liz Armstrong as members of the NHSBT clinical leadership team supporting organ donation and transplantation in the United Kingdom; and the transplant multidisciplinary clinical teams and patients across the United Kingdom. This work was carried out by NHSBT, an NHS special health authority with responsibility for organ donation and transplantation in the United Kingdom. Other than the authors, no other public or private entity had any role in study design, data analysis, data interpretation, or writing of the report. LM had full access to all of the data and was responsible for merging the linked datasets in the study. All authors had final responsibility for the decision to submit for publication.

Publisher Copyright:
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons

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