Ann Arbor, MI—
The risk organ-transplant recipients face form COVID-19 is affected by what medications they are prescribed, according to a new study.

A report in the journal Transplantation finds that risk of death from COVID-19 is greater in those treated with hydroxychloroquine (HCQ), an antimalarial drug with immunomodulatory action. That drug, along with the related drug chloroquine, which is used to treat malaria, has been touted as a cure or preventative for novel coronavirus infection, although those claims have generally been disproven.

“Using data from the COVID-19 Rapid Response Registry, we examined COVID-19 positive adult solid organ transplant recipients and non-transplant patients that were matched to them on age, race and whether they were admitted at the hospital or seen at an outpatient facility,” explained lead author Pratima Sharma, MD, an associate professor of medicine and a transplant hepatologist at Michigan Medicine.

The study notes that solid organ–transplant (SOT) recipients are considered to be more at risk from COVID-19 infection because of immunosuppression. To determine whether that is true, Michigan Medicine–led researchers conducted a case-control study comparing the outcomes of COVID-19 between SOT recipients and their matched nontransplant controls.
 
All 41 cases involved adult SOT recipients from the University of Michigan academic health center who were diagnosed with COVID-19 between March 10, 2020, and May 15, 2020 and used positive reverse transcriptase polymerase chain reaction for SARS-CoV2. The 121 controls were matched on age, race, and admission status, whether hospital or outpatient. Defined as the primary outcome was death, while severe disease, intubation, and renal replacement therapy (RRT) were secondary outcomes.

Participants with an SOT had a median age of 60 years and were 80% male and 67% Black.
 
Results indicate that severe disease-adjusted risk of death was similar in both the groups (hazard ration [HR] = 0.84[0.32-2.20]), while severity of COVID-19 and intubation were similar but the RRT use was higher in SOT (odds ratio [OR] = 5.32[1.26, 22.42]) compared to non-SOT COVID-19 patients.
 
Researchers report that, among SOT recipients, COVID-19-related treatment with HCQ was associated with ten-fold higher hazard of death compared to without HCQ (HR = 10.62[1.24-91.09]).

“Although African-Americans constituted one-tenth of all SOT in our center, they represented two-thirds of COVID-19 cases,” the authors point out. “Despite high RRT use in SOT recipients, the severe disease and short-term death were similar in both groups. HCQ for the treatment of COVID-19 among SOT recipients was associated with high mortality and therefore, its role as a treatment modality requires further scrutiny.”

Dr. Sharma notes that demographics of patients included in the study were also consistent with COVID-19 patient trends throughout the state of Michigan, adding, “Black Michiganders represent 15% of the total population in the state and account for 42% of COVID-19-related deaths, compared to white Michiganders who represent 75% of the population in the state and 26% of deaths from COVID-19.”

She goes on to explain, “These statistics are also valid for solid organ transplant recipients, and while Black patients account for one tenth of all organ transplant recipients in our University of Michigan Transplant Center, they represented two-thirds of the COVID-19 positive organ transplant recipients group in this study. These results highlight the racial inequities that have overwhelmed the United States health care system during this pandemic.”

Dr. Sharma said that HCQ treatment among organ-transplant recipients was associated with tenfold higher risk of death compared with not using the treatment.

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