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Abstract

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Background:

Solid organ transplant (SOT) recipients in Canada are particularly vulnerable to adverse hospital outcomes, especially during admissions involving a COVID-19 diagnosis. Limited evidence exists regarding how risks vary across different organ types and the extent to which a COVID-19 diagnosis influences hospital outcomes. This study aims to examine the association of organ subtypes on hospital morbidity and mortality, both in the presence and absence of a COVID-19 diagnosis in a large, nationally representative Canadian cohort.

Methods:

We used data from the Canadian Organ Replacement Register and the Discharge Abstract Database to examine hospitalization rates and in-hospital outcomes among all available adult SOT recipients with functioning grafts in Canada (excluding Quebec and Manitoba) from January 2021 to December 2022. In-hospital outcomes included transfer to a special care unit (SCU) and hospital mortality. Comparisons between organ subtypes (kidney, liver, heart, lung, and other/multi-organ) were conducted separately for admissions with and without a diagnosis of COVID-19, using kidney transplant (KT) recipients as the reference group. We included all admissions with a COVID-19 diagnosis irrespective of whether it was the primary reason for admission or not. Rates of hospitalization, SCU transfer, and mortality were analyzed using negative binomial or Poisson regression models (adjusted for age and sex) and reported using incidence rate ratios (IRRs) with 95% confidence intervals (CIs).

Results:

Among 23 497 SOT recipients, the majority (14 628, 62%) were KT recipients. Within this cohort, 2428 individuals (10.3%) experienced a total of 2925 hospitalizations with a COVID-19 diagnosis. In comparison, 7808 (33.2%) individuals experienced 17 656 hospitalizations without a COVID-19 diagnosis. Lung transplant recipients were more likely to be hospitalized (IRR = 1.65, 95% confidence interval CI: 1.52-1.80) and die in hospital (IRR = 1.2, 95% CI: 1.05-1.34) than KT recipients during admissions involving a COVID-19 diagnosis. In contrast, heart and liver transplant recipients were less likely to be hospitalized or experience a poor outcome. For hospitalizations without a COVID-19 diagnosis, lung and other/multi-organ transplant recipients were more likely than KT recipients to be hospitalized (IRR = 1.94, 95% CI: 1.76-2.15; IRR = 1.81, 95% CI: 1.45-2.26, respectively), transferred to an SCU (IRR = 1.89, 95% CI: 1.58-2.27; IRR = 1.81, 95% CI: 1.45-2.26, respectively), and die in hospital (IRR = 2.04, 95% CI: 1.84-2.27; IRR = 1.57, 95% CI: 1.33-1.85; respectively).

Conclusion:

SOT recipients in Canada, especially lung transplant recipients, experience high rates of hospitalization, SCU admission, and in-hospital mortality. Notable differences observed between organ subtypes for admissions with and without a COVID-19 diagnosis may reflect differences in immunosuppressive medication regimens, informing areas for future research.

Keywords

COVID-19 kidney transplant solid organ transplant mortality intensive care unit

Introduction

COVID-19 has had a major impact on solid organ transplant (SOT) recipients. Broad changes in transplantation practices, coupled with strict isolation measures, were initiated to decrease the impact of COVID-19.¹ Despite these changes to practice, the risk of mortality for kidney transplant (KT) recipients significantly increased soon after the onset of COVID-19² and persisted into the second wave.³ Poor outcomes have not been limited to recipients of KT, with several studies showing higher mortality rates in other SOT recipients,^4-6 especially among recipients of lung transplants, which may be the result of differences in immunosuppressive medication regimens or allograft-specific factors.⁷

In Canada, hospital outcomes of the COVID-19 pandemic among SOT recipients have mirrored those of international findings. A multicentre, prospective Canadian study of 509 SOT recipients found that transfers to intensive care units and mortality rates both varied from a low of 4% in each outcome for recipients of heart transplant to >30% in each outcome for recipients of lung transplants.⁸ Another prospective study followed outcomes in 161 SOT recipients with a COVID-19 diagnosis and found that transfers to intensive care units were significantly different between organ types (ranging from 0% in heart and kidney-pancreas transplant recipients to 33.3% in lung and heart-lung transplant recipients), but no significant difference in mortality was demonstrated.⁹ While informative, these studies included only SOT recipients with a COVID-19 diagnosis and therefore did not contrast COVID-19 outcomes to those unrelated to a COVID-19 diagnosis. This comparative study aims to quantify the burden of COVID-19 among SOT recipients in Canada, which may identify directions for further public policy development and inform clinical decision-making.

The objective of this study is to determine the risk of hospitalization and adverse hospital outcomes (including transfer to a higher acuity unit and in-hospital mortality) with and without a COVID-19 diagnosis in a large, nationally representative cohort of recipients of SOT in Canada. We hypothesize that lung transplant and KT recipients will experience higher rates of adverse events with a COVID-19 diagnosis than other organ recipients given the higher degree of immunosuppression, patient population, and, in the case of lung transplant recipients, organ-specific susceptibility.

Methods

Cohort and Data Linkage

We analyzed a cohort of all prevalent adults living with an SOT registered in the Canadian Organ Replacement Register (CORR) at the Canadian Institute for Health Information (CIHI) with a functioning transplant as of December 31, 2020. Solid organ transplant recipients were sub-categorized based on organ type, including kidney, liver, heart, lung, and a final category for other (inclusive of multi-organ, pancreas and bowel). Canadian Organ Replacement Register data have been previously validated for completeness in capture of transplants in Canada.¹⁰

Each SOT recipient registered in CORR was linked to CIHI’s Discharge Abstract Database (DAD) using their health card number, province, and year of birth to capture all hospitalizations between January 2021 and December 2022. The DAD includes administrative, clinical, and demographic information on hospital discharges. Up to 25 diagnoses may be captured for each patient using the Canadian International Classification of Diseases, 10th Revision (ICD-10-CA) codes.

Patients having received transplants in Manitoba or Quebec or those utilizing a Manitoba or Quebec health card were excluded because these provinces provide unencrypted data to CORR and encrypted data to DAD, precluding linkage.

Outcomes

We captured all hospitalization events for each patient in the cohort. Hospitalizations were divided into (1) those that included a diagnosis of COVID-19 based on a chart abstraction of the ICD-10-CA code U07.1 at discharge, irrespective of whether this was the primary reason for admission or (2) those without a COVID-19 diagnosis (i.e., without an ICD-10-CA diagnostic code U07.1).

Same-day procedures, outpatient procedures, and isolated emergency department visits without admission were not included. In addition to hospitalizations, we captured the in-hospital outcomes of transfers to a special care unit (SCU) (i.e., intensive care unit or intermediate care unit) and in-hospital mortality. In-hospital mortality was defined as all-cause and only included deaths occurring prior to discharge. Death events occurring outside of hospitalization were not included. Cause of death is not included in the CIHI DAD; thus, whether the death was attributed to COVID-19 or another cause could not be abstracted.

Statistical Analysis

Characteristics of the SOT recipients (both overall and stratified by organ type) were described using univariable statistics. Incidence rates expressed as events per 100 person-years (100PY) were reported for each outcome of interest. Rates of hospitalization, SCU transfer, and in-hospital mortality were analyzed using either a negative binomial model or, if the model did not converge, we used a Poisson regression with an overdispersion parameter. Comparisons of rates across organ subtype (with KT recipients as the reference group) were conducted separately for hospitalizations with and without a COVID-19 diagnosis. All models were adjusted for age and sex. Comorbidities and immunosuppressive medication regimen could not be derived from our data source and, thus, could not be accounted for in our models. Incidence rate ratios (IRRs) comparing other organ subtypes to KT were reported with 95% confidence intervals (CIs). Statistical significance of the IRRs was assessed using the Wald test with a 2-sided P value of < .05 considered statistically significant. All analyses were performed using SAS/STAT^® version 9.4 (SAS Institute Inc., Cary, North Carolina). Research ethics board review was provided by the Nova Scotia Research Ethics Board (#1030208).

Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) cohort reporting guidelines were used and are presented in Supplemental Table 1.¹¹

Results

The cohort consisted of 23 497 SOT recipients. Of those, the majority (14 628; 62.2%) were KT recipients, followed by liver (4531; 19.3%), lung (1785; 7.6%), heart (1407; 6.0%), and other/multi-organ (1146; 4.9%) transplant recipients. Additional demographic data, including age and sex distribution, are presented in Table 1 and Supplemental Table 2.

Table 1.

Demographics of SOT Recipients in Canada as of December 30, 2020.

	N	%
Age group
18-34	1772	7.54
35-49	4242	18.05
50-64	8880	37.79
65+	8603	36.61
Sex
Female	8709	37.06
Male	14 788	62.94
Province of treatment
BC	4736	20.16
AB	3954	16.83
SK	527	2.24
ON	12 660	53.88
NB	283	1.20
NS	1032	4.39
PE	76	0.32
NL	229	0.97
Organ transplant group
Kidney	14 628	62.25
Liver	4531	19.28
Heart	1407	5.99
Lung	1785	7.60
Other/multi-organ	1146	4.88
Race/ethnicity
White	13 555	57.69
Asian	1649	7.02
Black	775	3.30
Indian subcontinent	1356	5.77
Pacific Islander	605	2.57
Middle East/Arabian	456	1.94
Latin American	194	0.83
Unknown	4240	18.04
Other/multiracial	667	2.84
Total	23 497	100.00

Note. AB = Alberta; BC = British Columbia; NB = New Brunswick; NL = Newfoundland and Labrador; NS = Nova Scotia; ON = Ontario; PE = Prince Edward Island; SK = Saskatchewan.

Hospitalization Rates

Over the 24-month follow up, 2428 (10.3%) of all SOT recipients experienced a hospitalization with a COVID-19 diagnosis, corresponding to a hospitalization rate of 6.4 per 100PY, 95% CI of 6.2 to 6.7. Lung transplant recipients had the highest proportions and rates of such hospitalization. Specifically, 313 (17.5%) lung transplant recipients experienced one or more hospitalizations with a COVID-19 diagnosis during the study period at a rate of 11.9 per 100PY (95% CI: 10.8-13.0). In comparison, 1636 (11.2%) KT recipients had a hospitalization with a diagnosis of COVID-19, corresponding to a rate of 6.9 per 100PY (95% CI: 6.6-7.2). Absolute numbers of hospitalizations and adverse hospital outcomes can be found in Table 2 and IRRs are found in Table 3.

Table 2.

Hospitalizations, Special Care Unit Transfers, and Hospital Deaths for Admissions With and Without a Diagnosis of COVID-19.

	Total hospitalizations		Number of patients hospitalized		Total hospitalizations with SCU episode(s)		Number of patients hospitalized with SCU		Hospital deaths
Organ type	COVID+	COVID−	COVID+	COVID−	COVID+	COVID−	COVID+	COVID−	COVID+	COVID−
Kidney	1960 (67%)	10 016 (57%)	1636 (67%)	4608 (59%)	600 (74%)	1547 (57%)	537 (74%)	1156 (57%)	1960 (67%)	10 016 (57%)
Liver	231 (8%)	3340 (19%)	206 (8%)	1457 (19%)	49 (6%)	469 (17%)	47 (6%)	363 (18%)	231 (8%)	3340 (19%)
Heart	167 (6%)	978 (6%)	134 (6%)	452 (6%)	40 (5%)	174 (6%)	35 (5%)	134 (7%)	167 (6%)	978 (6%)
Lung	402 (14%)	2223 (13%)	313 (13%)	833 (11%)	84 (10%)	319 (12%)	75 (10%)	220 (11%)	402 (14%)	2223 (13%)
Other/multi-organ	165 (6%)	1119 (6%)	139 (6%)	458 (6%)	39 (5%)	196 (7%)	35 (5%)	146 (7%)	165 (6%)	1119 (6%)
Total	2925	17 676	2428	7808	812	2705	729	2019	526	944

Note. COVID+ = with a COVID-19 diagnosis; COVID- = without a COVID-19 diagnosis; SCU = special care unit.

Table 3.

Incidence Rates of Hospitalizations, Special Care Unit Transfers, and Hospital Deaths for COVID and Non-COVID Admissions by Type of Organ Transplanted.

	Incidence rate in 100PY (95% CI)
	With COVID diagnosis	Without COVID diagnosis
Hospitalization
Liver	2.6 (2.3-2.9)	37.8 (36.5-39.0)
Heart	6.1 (5.2-7.0)	35.6 (33.4-37.8)
Lung	11.9 (10.8-13.1)	65.9 (63.2-68.7)
Other/multi-organ	7.4 (6.3-8.5)	50.3 (47.3-53.2)
Kidney	6.9 (6.6-7.2)	35.3 (34.6-36.0)
Special care unit
Liver	0.6 (0.4-0.7)	5.3 (4.8-5.8)
Heart	1.5 (1.0-1.9)	6.3 (5.4-7.3)
Lung	2.5 (2.0-3.0)	9.5 (8.4-10.5)
Other/multi-organ	1.8 (1.2-2.3)	8.8 (7.6-10.0)
Kidney	2.1 (1.9-2.3)	5.5 (5.2-5.7)
Hospital death
Liver	0.4 (0.3-0.6)	1.9 (1.6-2.2)
Heart	1.0 (0.6-1.4)	1.6 (1.2-2.1)
Lung	1.8 (1.4-2.3)	4.3 (3.6-5.0)
Other/multi-organ	0.9 (0.5-1.2)	2.2 (1.6-2.9)
Kidney	1.3 (1.2-1.5)	1.9 (1.7-2.0)

Note. 100PY = 100 person-years; 95% CI = 95% confidence interval.

A total of 7808 SOT recipients (33.2%) were admitted to hospital without a COVID diagnosis corresponding to a rate of 38.8 hospitalizations per 100PY (95% CI: 38.2-39.4). These admission rates were proportionally higher among lung and other/multi-organ transplant recipients with rates of 65.9 (95% CI: 63.2-68.7) and 50.3 (95% CI: 47.3-53.2) hospitalizations per 100PY, respectively. Kidney transplant recipients had a rate of 35.3 hospitalizations per 100PY (95% CI: 34.6-36.0).

Adverse Hospital Outcomes

Among SOT recipients who were admitted with a COVID-19 diagnosis, 30% were admitted or transferred to an SCU, and 21.7% died in hospital. This corresponds to rates of 1.8 (95% CI: 1.7-1.9) per 100PY and 1.2 (95% CI: 1.1-1.3) per 100PY, respectively. Rates of SCU admissions were highest among lung transplant and KT recipients at 2.5 (95% CI: 2.0-3.0) per 100PY and 2.1 (95% CI: 1.9-2.3) per 100PY, respectively. Similarly, in-hospital mortality rates were higher among lung transplant and KT recipients at 1.8 (95% CI: 1.4-2.3) per 100PY and 1.3 (95% CI: 1.2-1.5) per 100PY, respectively.

Regarding admissions without a COVID-19 diagnosis, 25.9% of admitted SOT recipients were transferred to an SCU, which corresponds to a rate of 5.9 (95% CI: 5.7-6.2) per 100PY and 12.1% experienced an in-hospital death, which corresponds to a rate of 2.1 (95% CI: 1.9-2.2) per 100PY. Special care unit transfers during hospitalizations without a COVID-19 diagnosis were more common among lung and other/multi-organ recipients at rates of 9.5 (95% CI: 8.4-10.5) per 100PY and 8.8 (95% CI: 7.6-10.0) per 100PY, respectively. The same was true of in-hospital deaths with rates of 4.3 (95% CI: 3.6-5.0) per 100PY and 2.2 (95% CI: 1.6-2.9) per 100PY, respectively. Kidney transplant recipients without a diagnosis of COVID were admitted to SCU at a rate of 5.5 (95% CI: 5.2-5.7) per 100PY and experienced in-hospital mortality at a rate of 1.9 (95% CI: 1.7-2.0) per 100PY.

Outcomes Comparing Age and Sex

A subgroup analysis evaluating outcomes by sex identified a higher rate of in-hospital deaths among men (IRR = 1.30, 95% CI: 1.19-1.41) with a COVID-19 diagnosis, and lower rates of hospitalizations (IRR = 0.83, 95% CI: 0.78-0.88) for those without a COVID-19 diagnosis. No other sex-based differences were statistically significant.

Outcomes differed across age strata. Among those with a COVID-19 diagnosis, individuals aged 35 to 49, 50 to 64, and 65+ experienced higher rates of hospitalizations, SCU admissions, and hospital death compared with the 18 to 35 age group. Similarly, hospitalization and adverse hospital outcomes rates increased with age, although the differences were less pronounced without a COVID-19 diagnosis. (Supplemental Table 3).

Outcomes Comparing Transplanted Organs

When compared with KT recipients, liver and heart transplant recipients with a COVID-19 diagnosis had significantly lower hospitalization rates, with IRRs of 0.36 (95% CI: 0.32-0.40) and 0.87 (95% CI: 0.77-0.99), respectively. Conversely, lung transplant recipients had a higher rate of hospitalization (IRR = 1.65, 95% CI: 1.52-1.80). In-hospital mortality with a COVID-19 diagnosis mirrored these trends. Special care unit transfers, again, were less likely in liver and heart transplant recipients with IRRs of 0.23 (95% CI: 0.17-0.31) and 0.66 (95% CI: 0.45-0.95), but there were no higher rates of SCU transfers for lung transplant recipients (IRR = 1.15, 95% CI: 0.87-1.53) when compared with KT recipients.

In contrast, admissions without a COVID-19 diagnosis were more likely in liver transplant recipients than in KT recipients, (IRR = 1.09, 95% CI: 1.01-1.17). There were no significant differences in the incidence of adverse hospital outcomes between liver transplant and KT recipients. Lung transplant recipients were more likely to be hospitalized, admitted to SCU or experience a hospital death than KT recipients (IRRs = 1.94, 95% CI 1.76-2.15; 1.89, 95% CI: 1.58-2.27; and 2.04, 95% CI: 1.84-2.27; respectively). Similar findings were observed for other/multi-organ transplant recipients (IRRs = 1.56, 95% CI: 1.37-1.77; 1.81, 95% CI: 1.45-2.26; and 1.57, 95% CI: 1.33-1.85; respectively). These findings are shown in Table 3 and Figure 1.

Figure 1.

Effect across subgroups of organ type on outcomes.

Discussion

This study examines hospitalization rates and outcomes among SOT recipients with and without a COVID-19 diagnosis during the second through fifth waves of the pandemic between January 2021 and December 2022. It highlights significant differences in hospitalization rates, SCU transfers, and in-hospital mortality across organ types, age groups, and sexes. Our findings indicate that SOT recipients, particularly those of lung transplant and KT, experienced higher rates of hospitalization and adverse hospital outcomes with a COVID-19 diagnosis compared to recipients of other organs. Similar trends were observed in admissions without a COVID-19 diagnosis. We also observed notable differences in outcomes based on sex and age. Male recipients of SOT had higher rates of in-hospital deaths with a COVID-19 diagnosis and older age groups demonstrated increased hospitalization rates and adverse hospital outcomes.

Our findings are similar to those of a smaller multicentre, prospective Canadian study of 509 recipients of SOT, which demonstrated higher proportions of hospitalizations, SCU transfers, and death in kidney and lung transplant recipients.⁸ These findings also mirror international literature, which has demonstrated higher hospitalization and adverse hospital outcomes for lung transplant and KT recipients with COVID-19 and lower adverse events in liver transplant recipients.^4,12-15 One large study found that standardized mortality rates were higher in kidney (9.1, 95% CI: 8.4-9.9), lung (8.8, 95% CI: 7.1-10.8), and other/multi-organ (10.0, 95% CI: 8.2-12.2) transplant recipients and lower in liver transplant recipients (2.9, 95% CI 2.5-3.4).¹³ In a meta-analysis by An et al,⁴ the mortality rate of COVID-19 was 25.1% for lung transplant recipients, 19.8% for KT recipients, and 11.5% for liver transplant recipients.

In contrast to our findings, heart transplant recipients have previously been reported to have similar COVID-19 mortality rates as KT recipients. In the work of An et al,⁴ heart transplant recipients had COVID-19 mortality rates of 18.9%. An Italian study found that 30-day COVID-19 mortality in heart transplant recipients was not significantly different to that of KT recipients (odds ratio [OR] = 1.38, 95% CI: 0.75-2.56),¹⁵ and a large US study found a relative risk of 0.94 (95% CI: 0.75-1.18).¹⁶ These studies collected much of their data prior to our study period. The differences in heart transplant recipient outcomes may reflect variability across different waves of COVID-19 and new treatments for COVID-19 prevention and management. In a study of longitudinal outcomes among 2461 recipients of SOT, there was variability in hospitalization rates (highest for pre-Delta and lowest for some BA variants), for different variants.¹⁷ Vaccination rates also varied as the pandemic progressed. Studies have demonstrated that vaccines (and re-vaccination) are effective at reducing rates of hospitalization and death due to COVID-19 among SOT recipients,^18-20 although vaccine failure rates may be higher in recipients of SOT due to reduced immune response.²¹ Unfortunately, due to limitations in our data set, we were not able to determine vaccination status or test for similar results in our cohort. Future studies incorporating vaccination status of the Canadian SOT recipient population would help clarify its impact on outcomes.

Outcome differences based on the type of transplanted organ are likely multifactorial. The degree of immunosuppression, particularly with the use of corticosteroids, has previously been suggested as an important contributor with certain studies demonstrating both a lower risk of mortality with COVID-19 in SOT recipients on a corticosteroid-free regimen and a greater severity of COVID-19 infection in patients without SOTs and chronic steroid use.^22,23 Immunotolerance phenomena have also been proposed as an explanation for lower rates of COVID-19-related adverse events in liver transplant recipients.²⁴ In addition, direct viral effects on the lung allograft as demonstrated by increased tissue viral load may contribute to excess adverse events in recipients of this organ.²⁵

While a systematic review has not identified sex as a modifier of mortality in recipients of SOT with COVID-19,²⁶ our finding that male sex is associated with higher mortality in this population is consistent with other reports,^13,27 Similar results were reported in a large retrospective US cohort comprising 12 396 recipients of SOT evaluating COVID-related deaths between June 2020 and December 2022. Male sex has also been associated with increased COVID mortality in the general population.²⁸ It has been hypothesized that these differences relate to sex-related differences in immunity (males are reported to have fewer CD4+ T cells, CD8+ T cells, and B cells than females).²⁸ Others suggest sex hormones impact virus entry via angiotensin-converting enzyme 2 receptors by inducing higher receptor expression in males. In addition, males have a higher comorbidity burden, especially as it pertains to cardiac risk factors, which may contribute to excess mortality.²⁹

These results highlight the impact of COVID-19 on the transplant population in Canada. Approximately 2% of the prevalent Canadian KT population (excluding Quebec and Manitoba) hospitalized with a COVID-19 diagnosis experienced an in-hospital death with similar rates observed among heart (2%) and lung (3%) transplant recipients. Our findings demonstrate that this high risk extends nationally highlighting the vulnerability of transplant recipients to poor outcomes following viral infections, such as COVID-19. This observed vulnerability underscores the need for risk mitigation strategies, such as patient counseling and robust vaccination protocols to prevent COVID-19 infections and timely access to antiviral and immunomodulator therapy to prevent poor outcomes in this vulnerable population.

Our study has several strengths. To our knowledge, this is the largest Canadian study on COVID-19-related outcomes in recipients of SOT. Our access to CIHI’s DAD allowed a comparative analysis of admissions inclusive of whether the admission included a COVID-19 diagnosis. Finally, we were able to examine outcomes stratified by organ type, which was important given the differences we observed.

Our study has some limitations. While we were able to identify admissions that included a COVID-19 diagnosis, we were not able to ascertain whether the hospitalization (or ensuant outcome) was directly related to COVID-19. Therefore, it is possible that the contribution of COVID-19 to the event may have been overestimated. We were also unable to adjust for comorbidities, which may have affected the comparative results across organ type. Our data also lacked granularity regarding infection severity, concomitant diagnoses, type of immunosuppressive medication, time since transplantation, and immunization status, all of which may affect outcomes. In addition, deaths outside of the hospital setting were not recorded, which may result in outcome misclassification. The lack of data from Quebec and Manitoba may introduce patient selection bias and limit the national representativeness of this study; especially with Quebec reporting the highest proportion of COVID-19-related deaths early in the pandemic.³⁰ We may have underestimated national hospital outcome rates for this reason.

In conclusion, although COVID-19 does not account for the majority of hospitalizations, SCU transfer and hospital deaths, it has a significant impact on morbidity and mortality among SOT recipients in Canada. These findings underscore the continued need for targeted strategies to protect this high-risk population.

Supplemental Material

sj-docx-1-cjk-10.1177_20543581261434139 – Supplemental material for Impact of COVID-19 on Recipients of Solid Organ Transplants: A Cohort Study of In-Hospital Outcomes From the Canadian Organ Replacement Register

Supplemental material, sj-docx-1-cjk-10.1177_20543581261434139 for Impact of COVID-19 on Recipients of Solid Organ Transplants: A Cohort Study of In-Hospital Outcomes From the Canadian Organ Replacement Register by Jacob B. Michaud, Michael Manno, Katrina Sullivan, Nicole de Guia, Frank Ivis, Jagbir Gill, Annie-Claire Nadeau-Fredette, Louise Moist, S. Joseph Kim, Allison Dart and Karthik K. Tennankore in Canadian Journal of Kidney Health and Disease

Footnotes

ORCID iDs

Jacob B. Michaud

Jagbir Gill

Annie-Claire Nadeau-Fredette

Louise Moist

Allison Dart

Karthik K. Tennankore

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: J.B.M.—No potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

M.M.—No potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

K.S.—No potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Nd.G.—No potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

F.I.—No potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

A.T.—No potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

J.G.—No potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

A.C.N.F. holds a scholarship from Fonds de recherche du Québec—Santé and received honoraria for CME from Baxter.

L.M.—No potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

S.J.K.—No potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

A.D.—No potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

K.K.T. has received unrestricted grant funding from Otsuka for investigator-initiated projects and has conducted CME and Advisory Board work for Otsuka and Virtual Hallway.

Supplemental Material

Supplemental material for this article is available online.

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