Division of Nephrology, Department of Medicine, Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia, Canada.
Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Am J Transplant. 2024 Sep;24(9):1675-1689. doi: 10.1016/j.ajt.2024.06.001. Epub 2024 Jun 8.
Postacute sequelae after the coronavirus disease (COVID) of 2019 (PASC) is increasingly recognized, although data on solid organ transplant (SOT) recipients (SOTRs) are limited. Using the National COVID Cohort Collaborative, we performed 1:1 propensity score matching (PSM) of all adult SOTR and nonimmunosuppressed/immunocompromised (ISC) patients with acute COVID infection (August 1, 2021 to January 13, 2023) for a subsequent PASC diagnosis using International Classification of Diseases, 10th Revision, Clinical Modification codes. Multivariable logistic regression was used to examine not only the association of SOT status with PASC, but also other patient factors after stratifying by SOT status. Prior to PSM, there were 8769 SOT and 1 576 769 non-ISC patients with acute COVID infection. After PSM, 8756 SOTR and 8756 non-ISC patients were included; 2.2% of SOTR (n = 192) and 1.4% (n = 122) of non-ISC patients developed PASC (P value < .001). In the overall matched cohort, SOT was independently associated with PASC (adjusted odds ratio [aOR], 1.48; 95% confidence interval [CI], 1.09-2.01). Among SOTR, COVID infection severity (aOR, 11.6; 95% CI, 3.93-30.0 for severe vs mild disease), older age (aOR, 1.02; 95% CI, 1.01-1.03 per year), and mycophenolate mofetil use (aOR, 2.04; 95% CI, 1.38-3.05) were each independently associated with PASC. In non-ISC patients, only depression (aOR, 1.96; 95% CI, 1.24-3.07) and COVID infection severity were. In conclusion, PASC occurs more commonly in SOTR than in non-ISC patients, with differences in risk profiles based on SOT status.
2019 年冠状病毒病（COVID）的急性后遗症（PASC）日益受到关注，尽管有关实体器官移植（SOT）受者（SOTR）的数据有限。利用国家 COVID 队列协作研究，我们对所有成年 SOTR 和无免疫抑制/免疫功能低下（ISC）的急性 COVID 感染患者（2021 年 8 月 1 日至 2023 年 1 月 13 日）进行了 1:1 倾向评分匹配（PSM），以使用国际疾病分类，第十版，临床修正版代码诊断随后的 PASC。多变量逻辑回归不仅用于检查 SOT 状态与 PASC 的关联，还用于在按 SOT 状态分层后检查其他患者因素。在 PSM 之前，有 8769 名 SOT 和 1576769 名非 ISC 急性 COVID 感染患者。PSM 后，纳入 8756 名 SOTR 和 8756 名非 ISC 患者；SOTR 中有 2.2%（n=192）和非 ISC 患者中有 1.4%（n=122）发生 PASC（P 值<0.001）。在整个匹配队列中，SOT 与 PASC 独立相关（调整优势比 [aOR]，1.48；95%置信区间 [CI]，1.09-2.01）。在 SOTR 中，COVID 感染严重程度（aOR，11.6；95%CI，3.93-30.0 用于严重疾病与轻度疾病）、年龄较大（aOR，1.02；95%CI，每年 1.01-1.03）和吗替麦考酚酯使用（aOR，2.04；95%CI，1.38-3.05）均与 PASC 独立相关。在非 ISC 患者中，只有抑郁（aOR，1.96；95%CI，1.24-3.07）和 COVID 感染严重程度是相关的。总之，PASC 在 SOTR 中比在非 ISC 患者中更常见，基于 SOT 状态的风险特征存在差异。
