Incidence and outcome of SARS-CoV-2 infection on solid organ transplantation recipients: A nationwide population-based study

Since February 21 2020, when the Italian National Institute of Health (Istituto Superiore di Sanità-ISS) reported the first autochthonous case of infection, a dedicated surveillance system for SARS-CoV-2 positive (COVID+) cases has been created in Italy. These data were cross-referenced with those inside the Information Transplant System in order to assess the cumulative incidence (CI) and the outcome of SARS-COV-2 infection in solid organ transplant recipients (SOTRs) which is assumed to be most at risk. We compared our results with those of COVID+ non transplanted patients (Non-SOTRs) with followup through September 30, 2020. The CI of SARS-CoV-2 infection in SOTRs was 1.02%, higher than in COVID+ Non-SOTRs (0.4%, p<0.05) with a greater risk in the Lombardy region (2.89%). The CI by kind of organ transplant was higher for heart [CI 1.57%, Incidence Rate Ratio (IRR) 1.36] and lower for liver [CI 0.63%, IRR 0.54]. The 60dayCI of mortality was 30.6%, twice as much that of COVID+ Non-SOTRs (15.4%) with a 60day gender&age adjusted odds ratio (adjusted-OR) of 3.83 for COVID+ SOTRs [95%CI (3.03-4.85)]. The lowest 60day adjusted-OR was observed in liver SOTRs [OR 0.46, 95%CI (0.25-0.86)]. More detailed studies on disease management and evolution will be necessary in these patients at greater risk of COVID-19.