The prevalence of postacute sequelae of coronavirus disease 2019 in solid organ transplant recipients: Evaluation of risk in the National COVID Cohort Collaborative.

Postacute sequelae after the coronavirus disease (COVID) of 2019 (PASC) is increasingly recognized, although data on solid organ transplant (SOT) recipients (SOTRs) are limited. Using the National COVID Cohort Collaborative, we performed 1:1 propensity score matching (PSM) of all adult SOTR and nonimmunosuppressed/immunocompromised (ISC) patients with acute COVID infection (August 1, 2021 to January 13, 2023) for a subsequent PASC diagnosis using International Classification of Diseases, 10th Revision, Clinical Modification codes. Multivariable logistic regression was used to examine not only the association of SOT status with PASC, but also other patient factors after stratifying by SOT status. Prior to PSM, there were 8769 SOT and 1 576 769 non-ISC patients with acute COVID infection. After PSM, 8756 SOTR and 8756 non-ISC patients were included; 2.2% of SOTR (n = 192) and 1.4% (n = 122) of non-ISC patients developed PASC (P value < .001). In the overall matched cohort, SOT was independently associated with PASC (adjusted odds ratio [aOR], 1.48; 95% confidence interval [CI], 1.09-2.01). Among SOTR, COVID infection severity (aOR, 11.6; 95% CI, 3.93-30.0 for severe vs mild disease), older age (aOR, 1.02; 95% CI, 1.01-1.03 per year), and mycophenolate mofetil use (aOR, 2.04; 95% CI, 1.38-3.05) were each independently associated with PASC. In non-ISC patients, only depression (aOR, 1.96; 95% CI, 1.24-3.07) and COVID infection severity were. In conclusion, PASC occurs more commonly in SOTR than in non-ISC patients, with differences in risk profiles based on SOT status.

Vinson AJ ，Schissel M ，Anzalone AJ ，Dai R ，French ET ，Olex AL ，Lee SB ，Ison M ，Mannon RB ，National COVID Cohort Collaborative ... -  《-》

The Relative Risk of COVID-19 in Solid Organ Transplant Recipients Over Waves of the Pandemic.

Vinson AJ ，Anzalone AJ ，Schissel M ，Dai R ，Agarwal G ，Lee SB ，Olex A ，Mannon RB ... -  《-》

The risk and consequences of breakthrough SARS-CoV-2 infection in solid organ transplant recipients relative to non-immunosuppressed controls.

Clinical outcomes in solid organ transplant (SOT) recipients with breakthrough COVID (BTCo) after two doses of mRNA vaccination compared to the non-immunocompromised/immunosuppressed (ISC) general population, are not well described. In a cohort of adult patients testing positive for COVID-19 between December 10, 2020 and April 4, 2022, we compared the cumulative incidence of BTCo in a non-ISC population to SOT recipients (overall and by organ type) using the National COVID Cohort Collaborative (N3C) including data from 36 sites across the United States. We assessed the risk of complications post-BTCo in vaccinated SOT recipients versus SOT with unconfirmed vaccination status (UVS) using multivariable Cox proportional hazards and logistic regression. BTCo occurred in 4776 vaccinated SOT recipients over a median of 149 days (IQR 99-233), with the highest cumulative incidence in heart recipients. The relative risk of BTCo was greatest in SOT recipients (relative to non-ISC) during the pre-Delta period (HR 2.35, 95% CI 1.80-3.08). The greatest relative benefit with vaccination for both non-ISC and SOT cohorts was in BTCo mortality (HR 0.37, 95% CI 0.36-0.39 for non-ISC; HR 0.67, 95% 0.57-0.78 for SOT relative to UVS). While the relative benefit of vaccine was less in SOT than non-ISC, SOT patients still exhibited significant benefit with vaccination.

Vinson AJ ，Anzalone AJ ，Sun J ，Dai R ，Agarwal G ，Lee SB ，French E ，Olex A ，Ison MG ，Mannon RB ，N3C consortium ... -  《-》

Differentiation of Prior SARS-CoV-2 Infection and Postacute Sequelae by Standard Clinical Laboratory Measurements in the RECOVER Cohort.

Erlandson KM ，Geng LN ，Selvaggi CA ，Thaweethai T ，Chen P ，Erdmann NB ，Goldman JD ，Henrich TJ ，Hornig M ，Karlson EW ，Katz SD ，Kim C ，Cribbs SK ，Laiyemo AO ，Letts R ，Lin JY ，Marathe J ，Parthasarathy S ，Patterson TF ，Taylor BD ，Duffy ER ，Haack M ，Julg B ，Maranga G ，Hernandez C ，Singer NG ，Han J ，Pemu P ，Brim H ，Ashktorab H ，Charney AW ，Wisnivesky J ，Lin JJ ，Chu HY ，Go M ，Singh U ，Levitan EB ，Goepfert PA ，Nikolich JŽ ，Hsu H ，Peluso MJ ，Kelly JD ，Okumura MJ ，Flaherman VJ ，Quigley JG ，Krishnan JA ，Scholand MB ，Hess R ，Metz TD ，Costantine MM ，Rouse DJ ，Taylor BS ，Goldberg MP ，Marshall GD ，Wood J ，Warren D ，Horwitz L ，Foulkes AS ，McComsey GA ，RECOVER-Adult Cohort ... -  《-》

Risk factors associated with post-acute sequelae of SARS-CoV-2: an N3C and NIH RECOVER study.

More than one-third of individuals experience post-acute sequelae of SARS-CoV-2 infection (PASC, which includes long-COVID). The objective is to identify risk factors associated with PASC/long-COVID diagnosis. This was a retrospective case-control study including 31 health systems in the United States from the National COVID Cohort Collaborative (N3C). 8,325 individuals with PASC (defined by the presence of the International Classification of Diseases, version 10 code U09.9 or a long-COVID clinic visit) matched to 41,625 controls within the same health system and COVID index date within ± 45 days of the corresponding case's earliest COVID index date. Measurements of risk factors included demographics, comorbidities, treatment and acute characteristics related to COVID-19. Multivariable logistic regression, random forest, and XGBoost were used to determine the associations between risk factors and PASC. Among 8,325 individuals with PASC, the majority were > 50 years of age (56.6%), female (62.8%), and non-Hispanic White (68.6%). In logistic regression, middle-age categories (40 to 69 years; OR ranging from 2.32 to 2.58), female sex (OR 1.4, 95% CI 1.33-1.48), hospitalization associated with COVID-19 (OR 3.8, 95% CI 3.05-4.73), long (8-30 days, OR 1.69, 95% CI 1.31-2.17) or extended hospital stay (30 + days, OR 3.38, 95% CI 2.45-4.67), receipt of mechanical ventilation (OR 1.44, 95% CI 1.18-1.74), and several comorbidities including depression (OR 1.50, 95% CI 1.40-1.60), chronic lung disease (OR 1.63, 95% CI 1.53-1.74), and obesity (OR 1.23, 95% CI 1.16-1.3) were associated with increased likelihood of PASC diagnosis or care at a long-COVID clinic. Characteristics associated with a lower likelihood of PASC diagnosis or care at a long-COVID clinic included younger age (18 to 29 years), male sex, non-Hispanic Black race, and comorbidities such as substance abuse, cardiomyopathy, psychosis, and dementia. More doctors per capita in the county of residence was associated with an increased likelihood of PASC diagnosis or care at a long-COVID clinic. Our findings were consistent in sensitivity analyses using a variety of analytic techniques and approaches to select controls. This national study identified important risk factors for PASC diagnosis such as middle age, severe COVID-19 disease, and specific comorbidities. Further clinical and epidemiological research is needed to better understand underlying mechanisms and the potential role of vaccines and therapeutics in altering PASC course.

Hill EL ，Mehta HB ，Sharma S ，Mane K ，Singh SK ，Xie C ，Cathey E ，Loomba J ，Russell S ，Spratt H ，DeWitt PE ，Ammar N ，Madlock-Brown C ，Brown D ，McMurry JA ，Chute CG ，Haendel MA ，Moffitt R ，Pfaff ER ，Bennett TD ，N3C Consortium ，and the RECOVER Consortium ... -  《BMC PUBLIC HEALTH》