The Prevalence of Post-Acute Sequelae of COVID-19 in Solid Organ Transplant Recipients: Evaluation of Risk in the National COVID Cohort Collaborative (N3C).

Post-acute sequelae after COVID-19 (PASC) is increasingly recognized, though data in solid organ transplant recipients (SOTR) are limited. Using the N3C, we performed 1:1 propensity score matching (PSM) of all adult SOTR and non-immunosuppressed/immunocompromised (ISC) patients with acute COVID (08-01-2021 to 01-13-2023), for a subsequent PASC diagnosis using ICD-10-CM codes. Multivariable logistic regression was used to examine the association of SOT status with PASC, but also other patient factors after stratifying by SOT status. Prior to PSM, there were 8,769 SOT and 1,576,769 non-ISC patients with acute COVID. After PSM, 8,756 SOTR and 8,756 non-ISC patients were included; 2.2% of SOTR (n=192) and 1.4% (n=122) of non-ISC patients developed PASC (p-value<0.001). In the overall matched cohort, SOT was independently associated with PASC (aOR 1.48, 95% CI 1.09-2.01). Amongst SOTR, COVID severity (aOR 11.6, 95% CI 3.93-30.0 for severe versus mild disease), older age (aOR 1.02, 95% CI 1.01-1.03 per year), and mycophenolate mofetil use (aOR 2.04, 95% CI 1.38-3.05) were each independently associated with PASC. In non-ISC patients, only depression (aOR 1.96, 95% CI 1.24-3.07) and COVID severity were. In conclusion, PASC occurs more commonly in SOTR than non-ISC patients, with differences in risk profiles based on SOT status.

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