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Abstract
The role of immunosuppressive therapy on SARS-CoV-2 infection risk and COVID-19 severity remains unclear in unvaccinated solid organ transplant recipients. We included 1957 organ transplant recipients between July 2020 and April 2021 to analyze whether baseline immunosuppressive therapy and other risk factors are associated with SARS-CoV-2 infection and severe COVID-19. In total, 247 (12.6%) had SARS-CoV-2 (defined as positive nasopharyngeal swab and/or positive antibody titer). Of these, 57 (23.1%) had severe COVID-19, defined as oxygen supplementation, intensive care unit admission or death. Multivariable analysis identified diabetes (hazard ratio (HR) 1.39 (95% confidence interval (CI) 1.05–1.83)), chronic lung disease (HR 1.71 (95% CI 1.13–2.60)) and contact with a COVID-19 positive individual (HR 3.61 (95% CI 2.61–4.99) as independent risk factors for SARS-CoV-2 infection. There was no association between immunosuppressive therapy and infection risk. Severe COVID-19 was multivariably associated with hypertension (OR 5.45 (95% CI 1.66–17.84)), chronic kidney disease (OR 3.55 (95% CI 1.75–7.19)), corticosteroid use (OR 2.93 (95% CI 1.03–2.55)) and having a COVID-19 positive housemate (OR 6.77 (95% CI 2.65–17.28)). In conclusion, baseline corticosteroid use, but no other immunosuppressive agent, is independently associated with severe COVID-19 in unvaccinated SOT recipients after correction for hypertension, chronic kidney disease, housemates affected by COVID-19 and transplant type.
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1 University Hospitals Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium (GRID:grid.410569.f) (ISNI:0000 0004 0626 3338); CHROMETA, KU Leuven, Laboratory of Hepatology, Leuven, Belgium (GRID:grid.5596.f) (ISNI:0000 0001 0668 7884)
2 KU Leuven and Hasselt University, Department of Public Health and Primary Care, I-BioStat, Leuven, Belgium (GRID:grid.5596.f) (ISNI:0000 0001 0668 7884)
3 University Hospitals Leuven, Department of Laboratory Medicine, Leuven, Belgium (GRID:grid.410569.f) (ISNI:0000 0004 0626 3338); KU Leuven, Department of Microbiology, Immunology and Transplantation, Leuven, Belgium (GRID:grid.5596.f) (ISNI:0000 0001 0668 7884)
4 University Hospitals Leuven, Department of Cardiac Surgery, Leuven, Belgium (GRID:grid.410569.f) (ISNI:0000 0004 0626 3338); KU Leuven, Laboratory of Cardiovascular Sciences, Leuven, Belgium (GRID:grid.5596.f) (ISNI:0000 0001 0668 7884)
5 University Hospitals Leuven, Department of Thoracic Surgery, Leuven, Belgium (GRID:grid.410569.f) (ISNI:0000 0004 0626 3338); CHROMETA, KU Leuven, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Leuven, Belgium (GRID:grid.5596.f) (ISNI:0000 0001 0668 7884)
6 University Hospitals Leuven, Department of Abdominal Transplant Surgery, Leuven, Belgium (GRID:grid.410569.f) (ISNI:0000 0004 0626 3338); KU Leuven, Laboratory of Microbiology, Immunology and Transplantation, Leuven, Belgium (GRID:grid.5596.f) (ISNI:0000 0001 0668 7884)
7 Ziekenhuis Oost-Limburg Genk, Department of Gastroenterology and Hepatology, Genk, Belgium (GRID:grid.470040.7) (ISNI:0000 0004 0612 7379)
8 Jessa Hospital Hasselt, Department of Nephrology, Hasselt, Belgium (GRID:grid.414977.8) (ISNI:0000 0004 0578 1096)
9 University Hospitals Leuven, Department of Endocrinology, Leuven, Belgium (GRID:grid.410569.f) (ISNI:0000 0004 0626 3338); KU Leuven, Laboratory of Clinical and Experimental Endocrinology, CHROMETA, Leuven, Belgium (GRID:grid.5596.f) (ISNI:0000 0001 0668 7884)
10 University Hospitals Leuven, Department of Hematology, Leuven, Belgium (GRID:grid.410569.f) (ISNI:0000 0004 0626 3338); KU Leuven, Department of Public Health and Primary Care, ACCENT VV, Leuven, Belgium (GRID:grid.5596.f) (ISNI:0000 0001 0668 7884)
11 KU Leuven, Laboratory of Cardiovascular Sciences, Leuven, Belgium (GRID:grid.5596.f) (ISNI:0000 0001 0668 7884); University Hospitals Leuven, Department of Cardiology, Leuven, Belgium (GRID:grid.410569.f) (ISNI:0000 0004 0626 3338)
12 KU Leuven, Laboratory of Microbiology, Immunology and Transplantation, Leuven, Belgium (GRID:grid.5596.f) (ISNI:0000 0001 0668 7884); University Hospitals Leuven, Department of Nephrology and Renal Transplantation, Leuven, Belgium (GRID:grid.410569.f) (ISNI:0000 0004 0626 3338)
13 CHROMETA, KU Leuven, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Leuven, Belgium (GRID:grid.5596.f) (ISNI:0000 0001 0668 7884); University Hospitals Leuven, Department of Respiratory Diseases, Leuven, Belgium (GRID:grid.410569.f) (ISNI:0000 0004 0626 3338)