Sex and organ-specific risk of major adverse renal or cardiac events in solid organ transplant recipients with COVID-19

UMMS Affiliation

UMass Center for Clinical and Translational Science

Publication Date


Document Type



Cardiovascular Diseases | Infectious Disease | Nephrology | Surgery | Surgical Procedures, Operative | Translational Medical Research | Virus Diseases


While older males are at the highest risk for poor coronavirus disease 2019 (COVID-19) outcomes, it is not known if this applies to the immunosuppressed recipient of a solid organ transplant (SOT), nor how the type of allograft transplanted may impact outcomes. In a cohort study of adult ( > 18 years) patients testing positive for COVID-19 (January 1, 2020-June 21, 2021) from 56 sites across the United States identified using the National COVID Cohort Collaborative (N3C) Enclave, we used multivariable Cox proportional hazards models to assess time to MARCE after COVID-19 diagnosis in those with and without SOT. We examined the exposure of age-stratified recipient sex overall and separately in kidney, liver, lung, and heart transplant recipients. 3996 (36.4%) SOT and 91 646 (4.8%) non-SOT patients developed MARCE. Risk of post-COVID outcomes differed by transplant allograft type with heart and kidney recipients at highest risk. Males with SOT were at increased risk of MARCE, but to a lesser degree than the non-SOT cohort (HR 0.89, 95% CI 0.81-0.98 for SOT and HR 0.61, 95% CI 0.60-0.62 for non-SOT [females vs. males]). This represents the largest COVID-19 SOT cohort to date and the first-time sex-age-stratified and allograft-specific COVID-19 outcomes have been explored in those with SOT.


COVID-19, MACE, MARCE, SARS-CoV-2, age, allograft type, cardiac, gender, heart, infection, kidney, liver, lung, mortality, outcome, sex, solid organ transplantation, UMCCTS funding

DOI of Published Version



Vinson AJ, Dai R, Agarwal G, Anzalone AJ, Lee SB, French E, Olex AL, Madhira V, Mannon RB; National COVID Cohort Collaborative (N3C) Consortium. Sex and organ-specific risk of major adverse renal or cardiac events in solid organ transplant recipients with COVID-19. Am J Transplant. 2022 Jan;22(1):245-259. doi: 10.1111/ajt.16865. Epub 2021 Nov 1. PMID: 34637599; PMCID: PMC8653020. Link to article on publisher's site

Journal/Book/Conference Title

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons


The UMass Center for Clinical and Translational Science (UMCCTS), UL1TR001453, helped fund this study.

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