*Purpose: Transplantation has been disrupted dramatically by COVID-19 due to reallocation of healthcare resources and concerns from early reports of increased mortality rates (20-30%) in solid organ transplant recipients. Across the transplant population, up to 90% of patients are several years post-transplant and managed by primary care practitioners. Hence, it is important to understand if transplantation truly conveys additional risk and to differentiate predictors of outcomes associated with COVID-19 disease.

*Methods: The international COVID-19 transplant registry, www.c19txr.org, centralized global tracking of outcomes for transplant patients. COVID-19 cases were defined by positive PCR nasal swab. Seventeen countries and 57 centers participated (Jan 1-Dec 20, 2020). Data analysis was performed at two timepoints, differentiating global lockdowns.

*Results: There were 1619 kidney, 157 heart, 50 lung, 127 liver and 49 multi-visceral patients with COVID-19. Patient demographics are shown in Table 1. Of all cases, 8.7% required hospitalization, 3.9% required ventilation, and 2.2% of grafts failed (kidney only). Overall mortality was 7.1% at a median of 17.2 days after diagnosis. The risk of mortality in year 1 post-transplant was 34.3% (n=49) and 14.7% (n=21) within 90 days of T-cell depleting induction therapy. The need for dialysis led to 11% increase in mortality. A significant decrease in mortality rates was observed from 6.2% to 2.6% in patients with COVID-19 before and after July 2020 respectively; however, this differed by geographical location. Patients were asymptomatic in 19.7% of cases and 78.6% developed IgG and/or IgM antibodies (Table 2).

*Conclusions: Global registry data suggests overall risk of COVID-19, antibody response to infection and the associated mortality post-transplant mirror the general population. However, findings show higher risk of mortality within 90 days of T-cell depleting agents and within year 1 post-transplant, supporting modulation of immunosuppression during acute infection for these high-risk individuals. Racial data has shown disadvantaged groups experience higher mortality. The mortality data described here is consistent with geographical census statistics, with North and South America having a larger African population than Europe or Asia.

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