*Purpose: The current pandemic has created uncertainty in the severity of COVID-19 in transplant recipients, especially those given lymphocyte depleting therapy within a year prior to acquisition. Our experience was reviewed to stratify outcomes of COVID-19 infection occurring before or after one year from transplant.

*Methods: All COVID-19 PCR positive liver, pancreas and/or kidney transplant recipients with a minimum of 28 days follow up were reviewed for demographics and outcomes.

*Results: 216 recipients were identified: 20 <1 year and 196 >1 year post-transplant. Almost 80% were kidney alone or with pancreas or liver, ~ 2% pancreas alone and ~19% liver recipients. In the <1 year group 17 (85%) received thymoglobulin induction, 1 (5%) received thymoglobulin rejection treatment 8 days post-transplant and 3 (15%) received steroid rejection treatment 2, 2.5 and 10 months prior to COVID-19 diagnosis. Of recipients > 1 year from transplant there was 1 (0.5%) rejection treated with steroids 8 months prior to diagnosis. In the <1 year group 15% were asymptomatic at time of diagnosis. Both groups had a similar mortality rate. Infections diagnosed >1 year after transplantation had a higher hospitalization rate due to COVID-19, statistical significance was not feasible due to small sample size. There were patients in both groups hospitalized for other reasons. Of those hospitalized for COVID-19, 1 (20%) in the <1 year group was readmitted. This patient was diagnosed with COVID-19 due to fever and dyspnea 2 weeks following SPK, induction included thymoglobulin 2 mg/kg. Immunosuppression was decreased, patient was treated with dexamethasone and remdesivir, but ultimately was intubated and died 29 days following diagnosis. In the <1 year group an additional 4 patients were hospitalized, none of whom required intubation. It is likely that not all COVID-19 positive recipients were captured in this data for the >1 year post transplant group due to loss of follow up.

*Conclusions: With a limited experience, COVID-19 infection within the first year after transplantation does not appear to have a greater mortality or hospitalization rate after lymphocyte depletion induction contrasted to recipients acquiring COVID-19 greater than a year after transplantation.

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