Immunosuppressives heighten risk for COVID-19 hospitalization after solid organ transplant
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Key takeaways:
- During the study period, 11.4% of solid organ transplant recipients were hospitalized for COVID-19 infection.
- Mycophenolic acid, sirolimus and steroids were associated with an increased risk for hospitalization.
Mycophenolic acid, sirolimus and steroids were associated with an increased risk for COVID-19-related hospitalization among those who underwent kidney, liver, heart or lung transplant, data from JAMA Network Open showed.
“Solid organ transplant recipients (SOTRs) receive lifelong immunosuppressive drugs, drastically limiting the risk of transplant organ rejection,” Epiphane Kolla, MD, MPH, of the French National Agency for the Safety of Medicines and Health Products, and colleagues wrote. “Because of their immunosuppression combined with comorbidities, SOTRs are considered to be at high risk for severe forms of COVID-19. ... Immunosuppressive drugs to protect against graft rejection could be more or less associated with the risk of developing severe forms of COVID-19.
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“In addition, factors of COVID-19–related severity in this population, such as the time since transplantation or immunosuppression, are insufficiently explored in the literature.”
Using the French National Health Data System, researchers evaluated 60,456 transplant recipients (median age, 59 years; 63.7% men) who were on immunosuppressive drugs for the prevention of graft rejection. Most patients underwent kidney transplant (68.6%), followed by liver (23.9%), heart (8.8%) and lung transplants (4.6%).
From February 2020 to July 2022, 11.4% of the total study population was hospitalized for COVID-19 and 950 died. The median length of hospitalization stay was 5 days, with hospitalization rates of 12.7% for kidney, 6.4% for liver, 12.9% for heart and 18% for lung transplant recipients.
Among those who underwent kidney or liver transplant, steroids (adjusted OR = 1.6; 95% CI, 1.49-1.73 and aOR = 1.6; 95% CI, 1.38-1.86, respectively) and mycophenolic acid (aOR = 1.37; 95% CI, 1.25-1.51 and aOR = 1.61; 95% CI, 1.37-1.9) were associated with an increased risk for hospitalization, while tacrolimus (aOR = 0.77; 95% CI, 0.61-0.98) correlated with a decreased risk among liver transplant recipients.
Further, results showed cyclosporine (aOR = 0.67; 95% CI, 0.47-0.94) was associated with a decreased risk for hospitalization among heart transplant recipients, while steroids (aOR = 1.42; 95% CI, 1.11-1.82), mycophenolic acid (aOR = 1.29; 95% CI, 1.02-1.64), sirolimus (aOR = 2.71; 95% CI, 1.2-6.09) and everolimus (aOR = 1.24; 95% CI, 1.01-1.51) correlated with an increased risk.
Steroids were the only immunosuppressive agent associated with an increased risk for hospitalization among those who underwent lung transplant (aOR = 1.72; 95% CI, 1.19-2.48).
“Health care professionals should consider these results in treating SOTRs with SARS-CoV-2 infection by reducing doses or modifying medications in some cases,” Kolla and colleagues concluded. “These findings could also help health authorities make appropriate decisions for this population during future epidemics.”
They continued: “Nevertheless, further studies would be advisable to consolidate these findings.”
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