Maintenance immunosuppressive drugs, including steroids, used for organ transplant patients are associated with an increased risk of COVID-19 hospitalization in solid-organ transplant recipients, according to new findings.
The study, published yesterday in JAMA Network Open, was based on findings among a cohort of 60,456 solid-organ transplant recipients in France. The average age of participants was 59, and 63.7% were male. Patients were tracked from February 15, 2020, to July 31, 2022.
Among participants found in the French National Health Data System, 41,463 (68.6%) had kidney transplants, 14,464 (23.9%) had liver transplants, 5,327 (8.8%) had heart transplants, and 2,823 (4.6%) had lung transplants. Overall, 11.4% were hospitalized for COVID-19, including 12.7% of kidney transplant recipients, 6.4% of liver transplant recipients, 12.9% of heart transplant recipients, and 18.0% of lung transplant recipients.
Heart transplant patients at greatest risk
In kidney transplant recipients, steroids (adjusted odds ratio [AOR], 1.60; 95% confidence interval [CI], 1.49 to 1.73) and mycophenolic acid (AOR, 1.37; 95% CI, 1.25 to 1.51) were associated with a high risk of hospitalization.
Steroids were also associated with an increased risk of hospitalization for COVID-19.
“We observed an increased risk of COVID-19 hospitalization associated with using sirolimus in heart transplant recipients and using mycophenolic acid in kidney and liver transplant recipients independent of other drugs,” the authors wrote. “Steroids were also associated with an increased risk of hospitalization for COVID-19 in each transplant subgroup.”
Tacrolimus and cyclosporine were the only two maintenance therapies associated with a low risk of hospitalization in liver and heart transplant recipients, respectively.
Among all participants, heart transplant recipients treated with sirolimus were at the greatest increased risk of COVID-19 hospitalization (AOR, 2.71; 95% CI, 1.20 to 6.09).