Delayed Mortality Among Solid Organ Transplant Recipients Hospitalized for Coronavirus Disease 2019

Background. Most studies of solid organ transplant (SOT) recipients with coronavirus disease 2019 (COVID-19) focus on outcomes within 1 month of illness onset. Delayed mortality in SOT recipients hospitalized for COVID-19 has not been fully examined. Methods. We used data from a multicenter registry to calculate mortality by 90 days following initial acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection in SOT recipients hospitalized for COVID-19 and developed multivariable Cox proportional hazards models to compare risk factors for death by days 28 and 90. Results. Vital status at day 90 was available for 936 of 1117 (84%) SOT recipients hospitalized for COVID-19; 190 of 936 (20%) died by 28 days, and an additional 56 of 246 deaths (23%) occurred between days 29 and 90. Factors associated with mortality by day 90 included age >65 years (adjusted hazard ratio [aHR], 1.8 [1.3-2.4]; P <.001), lung transplant (vs nonlung transplant; aHR, 1.5 [1.0-2.3]; P =.05), heart failure (aHR, 1.9 [1.2-2.9]; P =.006), chronic lung disease (aHR, 2.3 [1.5-3.6]; P <.001), and body mass index =30 kg/m2 (aHR, 1.5 [1.1-2.0]; P =.02). These associations were similar for mortality by day 28. Compared with diagnosis during early 2020 (1 March 2020-19 June 2020), diagnosis during late 2020 (20 June 2020-31 December 2020) was associated with lower mortality by day 28 (aHR, 0.7 [0.5-1.0]; P =.04) but not by day 90 (aHR, 0.9 [0.7-1.3]; P =.61). Conclusions. In SOT recipients hospitalized for COVID-19, >20% of deaths occurred between 28 and 90 days following SARSCoV-2 diagnosis. Future investigations should consider extending follow-up duration to 90 days for more complete mortality assessment.