*Purpose: We characterized the outcomes of COVID-19 in our population of solid organ transplant recipients (SOTRs). Since these individuals are immunocompromised, with multiple comorbidities, we hypothesized that they would be at increased risk of COVID-19 related complications and manifest delayed viral clearance.

*Methods: A single-center retrospective chart review was conducted of all COVID-19 positive SOTRs in our hospital system from March to November 2020. Variables of interest included demographic data, clinical course, virologic assays, clinical suspicion for graft dysfunction, and biopsy results. Re-admissions within 60 days of discharge were recorded, as were persisting positive SARS-CoV2 PCR tests >4 weeks from initial diagnosis.

*Results: We identified 60 SOTRs who tested positive for COVID-19 by nasopharyngeal swab PCR. This included 40 renal, 17 liver, and 9 heart, lung, pancreas, or small bowel transplant recipients (“other”). 7 patients had received dual organs. 66.6% were men and 63% African American. The most common comorbidities were hypertension (88%), chronic kidney disease as defined by an abnormal Cr (68%), diabetes (50%), and obesity defined by BMI >30 (33%). Forty patients required hospitalization, with a median 6.5-day length of stay. 15 were admitted to an ICU, including 8 who required mechanical ventilation and 3 who required oxygen via high flow nasal cannula. Other outcomes are summarized in the Table. The readmission rate was high, and a 9.3% mortality rate was found in non-liver transplant recipients. In general, immunosuppression management consisted of antimetabolite and calcineurin inhibitor dose reduction. However, graft rejection was not proven on biopsy, despite being suspected in 3 cases (2 kidney, 1 liver).

*Conclusions: COVID-19 in SOTRs results in higher rates of hospitalization, ICU admission, and death, as compared to reported outcomes in the general population. Our series showed clinical variability depending on type of organ transplant, with worse outcomes in non-liver transplant recipients. As we move toward the approval and distribution of effective vaccines, it is important to recognize that SOTRs represent a group that is particularly vulnerable to this virus, and would benefit from early access to preventive strategies.

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