*Purpose: The purpose of this study is to evaluate outcomes of readmission, rejection, graft dysfunction, graft failure, and death in SOT recipients (SOTR) after COVID-19 infection.

*Methods: We conducted a retrospective cohort study of SOTR diagnosed with COVID-19 infection before 5/1/2021. COVID-19 disease severity was assigned retrospectively by NIH criteria and grouped into asymptomatic/mild and moderate/severe/critical infection. Data collected included demographics, clinical features, treatment, and outcomes. Bivariate comparisons to evaluate characteristics associated with outcomes were performed with independent group t-tests for continuous variables and Fisher’s exact tests for categorical variables.

*Results: 138 SOTR were diagnosed with COVID-19 at a median of 5 (IQR 3-8) years post-transplant with a mean age of 57±12 years at diagnosis. Most were kidney or liver recipients (Table 1); 49 (36%) had asymptomatic or mild infection. 29 (21%) of SOTR had moderate, 26 (19%) severe, and 31 (22%) critical infection. Disease severity, treatment with steroids or remdesivir did not correlate with rejection. Most graft failures occurred in SOTR with critical (n=12) disease (Table 2). 102 (74%) SOTR were admitted to the hospital for COVID-19 infection, of which 27 (26%) were readmitted more than 2 months after their index hospitalization. Of the readmissions, 5 were for renal complications, 5 infectious, and 7 pulmonary. Among those hospitalized, 13 (13%) SOTR died during the index admission. Among the 27 SOTR who were readmitted, 3 (11%) SOTR died during readmission. The mean time from initial infection to death was 121±176 days.

*Conclusions: In this cohort, disease severity was associated with graft failure. Readmissions were frequent more than 2 months after the index admission. Mortality in those who were readmitted remained high. Rejection was relatively infrequent.

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