COVID-19 in Solid Organ Transplant Recipients: Initial Report from the US Epicenter

Solid organ transplant recipients may be at a high risk for SARS-CoV2 infection and poor associated outcomes. We herein report our initial experience with solid organ transplant recipients with SARS-CoV2 infection at two centers during the first 3 weeks of the outbreak in New York City. Baseline characteristics, clinical presentation, antiviral and immunosuppressive management were compared between patients with mild/moderate and severe disease (defined as ICU admission, intubation or death). 90 patients were analyzed with a median age of 57 years. 46 were kidney recipients, 17 lung, 13 liver, 9 heart and 5 dual-organ transplants. The most common presenting symptoms were fever (70%), cough (59%) and dyspnea (43%). 22 (24%) had mild, 41 (46%) moderate and 27 (30%) severe disease. Among the 68 hospitalized patients, 12% required non-rebreather and 35% required intubation. 91% received hydroxychloroquine, 66% azithromycin, 3% remdesivir, 21% tocilizumab and 24% bolus steroids. Sixteen patients died (18% overall, 24% of hospitalized, 52% of ICU) and 37 (54%) were discharged. In this initial cohort, transplant recipients with COVID-19 appear to have more severe outcomes, although testing limitations likely led to undercounting of mild/asymptomatic cases. As this outbreak unfolds, COVID-19 has the potential to severely impact solid organ transplant recipients.