*Purpose: By the early spring of 2020, the United States has become the global epicenter of the coronavirus 2019 (COVID-19) pandemic. Little is known if immunocompromised hosts such as solid organ transplant recipients are affected differently by COVID-19 – in terms of their presentation, their laboratory values, the management of their immunosuppression, and their outcomes. We describe a cohort of 25 solid organ transplant patients who were symptomatic and infected with COVID- 19 at a single institution at Baylor St. Luke’s in Houston, Texas.

*Methods: Using the electronic medical record, 25 solid organ transplant recipients (18 kidney, 2 liver/kidney, 2 liver, 2 heart, and 1 lung transplant) were identified with SARS-CoV2 infection from March 19^th, 2020 until July 14^th, 2020 at Baylor St Luke’s Medical Center in Houston, Texas. We then cataloged their hospitalization course to include changes in immunosuppression therapy, need for intensive care, ventilator support, as well as COVID-19 directed therapy and report their outcomes.

*Results: These patients have many comorbidities (96% with hypertension, 60% with heart failure or ischemic heart disease, and 60% with diabetes) alongside their immunocompromised status. Immunosuppression therapy was weaned in all but 2 stable liver transplant patients on minimal maintenance immunosuppression. Kidney SOTR patients often had atypical symptoms such as diarrhea (39%). Overall SOTR patients frequently presented with AKI (44%), frequently required ICU stay (52%), and frequently required intubation (36%). Notably, we discovered a large racial/ethnic disparity in COVID-19 infection as all our patients are minorities and 24 of 25 patients are of Hispanic ethnicity or African American race. In addition, 72% of our infected patients had Medicare or Medicaid as their primary health insurance – compared to our baseline of 46%.

*Conclusions: We have found solid organ transplant patients had more atypical symptoms such as diarrhea and CT imaging can be more accurate and timely in diagnosis. In regards to clinical management, a stepwise reduction/discontinuation of immunosuppression based on disease severity appears to be a safe and pragmatic model of care. Furthermore, we too have found that a significant racial and ethnic disparity exists for African-American and Hispanic transplant recipients becoming infected with COVID-19. Yet again, minorities and those more socioeconomically disadvantaged continue to bear the brunt of chronic disease, even after they receive their transplantation.

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