Comparing the Post‐Omicron Impact of COVID‐19 and Non‐COVID‐19 Respiratory Viral Infections in Solid Organ Transplant Recipients
Beatrice Z. Sim, Julie M. Steinbrink, Madeleine R. Heldman, Arthur W. Baker, Julia A. Messina, Sana Arif, Bin Ni, Patrick C. K. Tam, Manuela Carugati, Jordan Mah, Matthew Goodwin, Ilan S. Schwartz, Monica A. Slavin, Michelle K. Yong, Cameron R. WolfeABSTRACT
Introduction
Effective treatment and prevention for respiratory viral infections (RVI) in solid organ transplant recipients (SOTR) are lacking; clinical differences in COVID‐19 and non‐COVID‐19 (ncRVI) post‐omicron are unknown. We compared severity and outcomes across SOT groups.
Methods
A single‐center retrospective study of health system RVI in adult SOTR during 2022‐2023 was conducted.
Results
Overall, 520 RVI episodes in 504 patients were included: 488 had 1 episode and 16 had 2 episodes. Lung, kidney, and heart transplant recipients comprised of 40.9%, 34.3%, and 20.8% of the cohort. There were 352 episodes of COVID‐19 RVI and 148 ncRVI. All‐cause and RVI‐related hospitalization were comparable between COVID‐19 and ncRVI (47.7% vs. 43.9%, p = 0.50; 32.1% vs. 31.1%, p = 0.91 respectively). Oxygen supplementation occurred in 11.9% of COVID‐19 RVI and 11.5% of ncRVI with a maximum requirement (median, IQR) of 4.0 (2.0‐18.8) and 2.0 (2.0‐3.0) liters respectively ( p = 0.005). Intensive care unit (ICU) admission occurred in 7.1% and 6.1%; non‐invasive ventilation (NIV) in 2.3% and 4.1%; mechanical ventilation (I&V) in 4.0% and 2.0%; and inotropic/vasopressor support in 1.7% and 1.4%, for COVID‐19 versus nCRVI, respectively. Patients with COVID‐19 had ongoing symptoms in 16.8%, 10.2%, and 2.6% at 30 days, 3 month, and 12 month follow up respectively, compared with 16.9%, 4.7%, and 2.0% in ncRVI. Twelve‐month mortality, rejection and graft dysfunction were similar between groups.
Conclusions
COVID‐19 and ncRVI pose significant and comparable risk to SOTR in this post‐omicron era, in hospitalization, oxygen requirement, and persistent symptoms. Treatment and prevention should be prioritized in this population.