Is the Omicron variant truly less virulent in solid organ transplant recipients?
COVID-19
SARS-CoV-2
omicron
solid organ transplant
Journal
Transplant infectious disease : an official journal of the Transplantation Society
ISSN: 1399-3062
Titre abrégé: Transpl Infect Dis
Pays: Denmark
ID NLM: 100883688
Informations de publication
Date de publication:
Dec 2022
Dec 2022
Historique:
revised:
04
06
2022
received:
07
04
2022
accepted:
24
06
2022
pubmed:
3
8
2022
medline:
24
12
2022
entrez:
2
8
2022
Statut:
ppublish
Résumé
Solid organ transplant (SOT) recipients are at high risk for severe disease with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Emerging variants of concern have disproportionately affected this population. Data on severity and outcomes with the Omicron variant in SOT recipients are limited. Thus we conducted this single-center, retrospective cohort study of SOT recipients diagnosed with SARS-CoV-2 infection from December 18, 2021 to January 18, 2022, when prevalence of the Omicron variant was more than 80%-95% in the community. Univariate and multivariate logistic regression analysis was performed to identify risk factors for hospital admission. We identified 166 SOT patients: 112 (67.5%) kidney, 22 (13.3%) liver, 10 (6.0%) lung, seven (4.2%) heart, and 15 (9.0%) combined transplants. SARS-CoV-2 vaccine series was completed in 59 (35.5%) recipients. Ninety-nine (59.6%) and 13 (7.8%) recipients received casirivimab/imdevimab and sotrovimab, respectively. Fifty-three (32%) recipients required hospital admission, of which 19 (35.8%) required intensive care unit level of care. Median follow-up was 50 (interquartile range, 25-59) days, with mortality reported in six (3.6%) patients. Risk factors identified for hospital admission were African American race (p < .001, odds ratio [OR] 4.00, 95% confidence interval [CI] 1.84-8.70), history of coronary artery disease (p = .031, OR 3.50, 95% CI 1.12-10.87), and maintenance immunosuppression with corticosteroids (p = .048, OR 2.00, 95% CI 1.01-4.00). In conclusion, contrary to that in the general population, we found a higher hospital admission rate in SOT recipients with omicron variant infection. Further studies to investigate the efficacy of newer treatments are necessary, even as outcomes continue to improve.
Identifiants
pubmed: 35915957
doi: 10.1111/tid.13923
pmc: PMC9538470
doi:
Substances chimiques
COVID-19 Vaccines
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13923Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
Raja MA, Mendoza MA, Villavicencio A, et al. COVID-19 in solid organ transplant recipients: a systematic review and meta-analysis of current literature. Transplant Rev (Orlando). 2020;35(1):100588.
Kumar D, Manuel O, Natori Y, et al. COVID-19: a global transplant perspective on successfully navigating a pandemic. Am J Transplant. 2020;20(7):1773-1779.
Chandorkar A, Coro A, Natori Y, et al. Kidney transplantation during coronavirus 2019 pandemic at a large hospital in Miami. Transpl Infect Dis. 2020;22(6):e13416.
Kates OS, Haydel BM, Florman SS, et al. COVID-19 in solid organ transplant: a multi-center cohort study. Clin Infect Dis. 2020;73(11):e4090-e4099.
Qin CX, Moore LW, Anjan S, et al. Risk of breakthrough SARS-CoV-2 infections in adult transplant recipients. Transplantation. 2021;105(11):e265-e266.
Hall VG, Ferreira VH, Ku T, et al. Randomized trial of a third dose of mRNA-1273 vaccine in transplant recipients. N Engl J Med. 2021;385(13):1244-1246.
Kamar N, Abravanel F, Marion O, et al. Assessment of 4 doses of SARS-CoV-2 messenger RNA-based vaccine in recipients of a solid organ transplant. JAMA Netw Open. 2021;4(11):e2136030.
Tixagevimab and cilgavimab (Evusheld) for pre-exposure prophylaxis of COVID-19. JAMA. 2022;327(4):384-385.
This is unprecedented: Omicron causes 80% of coronavirus cases in Miami-Dade in 2 weeks. 2021. Accessed July 5, 2022. https://www.local10.com/news/local/2021/12/17/this-is-unprecedented-omicron-causes-80-of-coronavirus-cases-in-miami-dade-in-2-weeks/
WHO R&D Blueprint. COVID-19 therapeutic trial synopsis. Accessed December 16, 2020. https://www.who.int/publications-detail/covid-19-therapeutic-trial-synopsis
Gottlieb RL, Vaca CE, Paredes R, et al. Early Remdesivir to prevent progression to severe Covid-19 in outpatients. N Engl J Med. 2022;386(4):305-315.
Group RC, Horby P, Lim WS, et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med. 2021;384(8):693-704.
Faqihi F, Alharthy A, Abdulaziz S, et al. Therapeutic plasma exchange in patients with life-threatening COVID-19: a randomised controlled clinical trial. Int J Antimicrob Agents. 2021;57(5):106334.
Iuliano AD, Boehmer JM, Boehmer TK, et al. Trends in disease severity and health care utilization during the early Omicron variant period compared with previous SARS-CoV-2 high transmission periods - United States, December 2020-January 2022. MMWR Morb Mortal Wkly Rep 2022;71:146-152.
Acosta AM, Garg S, Pham H, et al. Racial and ethnic disparities in rates of COVID-19-associated hospitalization, intensive care unit admission, and in-hospital death in the United States from March 2020 to February 2021. JAMA Netw Open. 2021;4(10):e2130479.
Ko JY, Danielson ML, Town M, et al. Risk factors for Coronavirus Disease 2019 (COVID-19)-associated hospitalization: COVID-19-associated hospitalization surveillance network and behavioral risk factor surveillance system. Clin Infect Dis. 2021;72(11):e695-e703.
Heldman MR, Kates OS, Safa K, et al. Changing trends in mortality among solid organ transplant recipients hospitalized for COVID-19 during the course of the pandemic. Am J Transplant. 2022;22(1):279-288.
Solera JT, Arbol BG, Alshahrani A, et al. Impact of vaccination and early monoclonal antibody therapy on COVID-19 outcomes in organ transplant recipients during the Omicron wave. Clin Infect Dis. 2022. doi: 10.1093/cid/ciac324
Villanego F, Vigara LA, Alonso M, et al. Trends in COVID-19 outcomes in kidney transplant recipients during the period of Omicron variant predominance. Transplantation. 2022;106(6):e304-e305.
Heldman MR, Kates OS, Safa K, et al. Delayed mortality among solid organ transplant recipients hospitalized for COVID-19. Clin Infect Dis. 2022. doi: 10.1093/cid/ciac159
Behr CL, Joynt Maddox KE, Meara E, Epstein AM, Orav EJ, Barnett ML. Anti-SARS-CoV-2 monoclonal antibody distribution to high-risk medicare beneficiaries, 2020-2021. JAMA. 2022;327(10):980983.
Bierle DM, Ganesh R, Wilker CG, et al. Influence of social and cultural factors on the decision to consent for monoclonal antibody treatment among high-risk patients with mild-moderate COVID-19. J Prim Care Community Health. 2021;12:21501327211019282.