Comparison of COVID-19 Hospitalization and Death Between Solid Organ Transplant Recipients and the General Population in Canada, 2020-2022

Kyla L Naylor; Gregory A Knoll; Darin Treleaven; Yuguang Kang; Amit X Garg; Kathryn Stirling; S Joseph Kim

doi:10.1097/TXD.0000000000001670

Comparison of COVID-19 Hospitalization and Death Between Solid Organ Transplant Recipients and the General Population in Canada, 2020-2022

Transplant Direct. 2024 Jun 26;10(7):e1670. doi: 10.1097/TXD.0000000000001670. eCollection 2024 Jul.

Authors

Kyla L Naylor^{1

2

3}, Gregory A Knoll⁴, Darin Treleaven⁵, Yuguang Kang^{1

3}, Amit X Garg^{1

2

3}, Kathryn Stirling³, S Joseph Kim^{1

6}

Affiliations

¹ ICES, ON, Canada.
² Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.
³ Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada.
⁴ Department of Medicine (Nephrology), University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁵ Trillium Gift of Life Network, Ontario Health, ON, Canada.
⁶ Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada.

Abstract

Background: Solid organ transplant recipients have a high risk of severe outcomes from SARS-CoV-2 infection. A comprehensive understanding of the impact of the COVID-19 pandemic across multiple waves in the solid organ transplant population and how this compares to the general population is limited. We conducted a population-based cohort study using linked administrative healthcare databases from Ontario, Canada to answer this question.

Methods: We included 15 306 solid organ transplant recipients and 12 160 904 individuals from the general population. Our primary outcome was the rate (per 100 person-years) of severe COVID-19 (ie, hospitalization or death with a positive SARS-CoV-2 test) occurring between January 25, 2020, and November 30, 2022.

Results: Compared with the general population, solid organ transplant recipients had almost a 6 times higher rate of severe COVID-19 (20.39 versus 3.44 per 100 person-years), with almost 5.5 times as high a rate of death alone (4.19 versus 0.77 per 100 person-years). Transplant recipients with severe COVID-19 were substantially younger (60.1 versus 66.5 y) and had more comorbidities. The rate of severe COVID-19 declined over time in the solid organ transplant population, with an incidence rate of 41.25 per 100 person-years in the first wave (January 25, 2020, to August 31, 2020) and 18.41 in the seventh wave (June 19, 2022, to November 30, 2022, Omicron era).

Conclusions: Solid organ transplant recipients remain at high risk of severe outcomes when they are infected with SARS-CoV-2. Resources and strategies to mitigate the impact of SARS-CoV-2 exposure are needed in this vulnerable patient population.