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.

中文翻译：

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COVID-19 实体器官移植受者发生主要肾脏或心脏不良事件的性别和器官特异性风险

虽然老年男性罹患 2019 年冠状病毒病 (COVID-19) 预后不良的风险最高，但尚不清楚这是否适用于实体器官移植 (SOT) 的免疫抑制受者，也不知道移植的同种异体移植物类型如何影响结果。在一项对来自美国 56 个地点的 COVID-19 检测呈阳性的成人（> 18 岁）患者（2020 年 1 月 1 日至 2021 年 6 月 21 日）进行的队列研究中，我们使用国家 COVID 队列协作 (N3C) Enclave 确定的多变量 Cox 比例风险模型，用于评估患有和不患有 SOT 的患者在诊断出 COVID-19 后达到 MARCE 的时间。我们总体和单独检查了肾、肝、肺和心脏移植受者中按年龄分层的受者性别的暴露情况。3996 名（36.4%）SOT 患者和 91 646 名（4.8%）非 SOT 患者发生了 MARCE。新冠肺炎后结果的风险因移植同种异体移植类型而异，其中心脏和肾脏受者的风险最高。患有 SOT 的男性患 MARCE 的风险增加，但程度低于非 SOT 队列（SOT 的 HR 0.89，95% CI 0.81–0.98，非 SOT 的 HR 0.61，95% CI 0.60–0.62 [女性 vs .男性]）。这是迄今为止最大的 COVID-19 SOT 队列，并且首次在 SOT 患者中探索了按性别年龄分层和同种异体移植特异性的 COVID-19 结果。