COVID-19 infections among 2,400 vaccinated transplant recipients were common (19.7%) during SARS-CoV-2 Omicron variant predominance in the United States, but only 7.5% needed hospitalization, estimates a study published late last week in JAMA Network Open.
Researchers at New York University and Johns Hopkins University surveyed participants in a national cohort who reported receiving at least one COVID-19 vaccine dose from January 2021 through December 2022. The team sent follow-up surveys in January and June 2022.
Lung recipients hospitalized more often
Among 2,461 transplant recipients, 19.7% reported a COVID-19 infection, including 15 reinfections. The case incidence per 1 million person-days was 90 before the Delta variant era (January to May 2021), 304 during Delta (June to December 2021), 1,292 during Omicron BA.1 (January to March 2022), 1,051 during BA.2 (April to June 2022), and 1,066 amid BA.4, BA.5, and BQ.1 (July to December 2022).
COVID-19 incidence was lower among participants 60 years or older than among younger participants (420.2 vs 605.0, respectively) and similar if less than 2 years had elapsed since transplant (vs more than 2 years; 599.6 vs 485.7) and in lung versus nonlung recipients (572.8 vs 500.4). The incidence among transplant recipients followed a similar trajectory as among the general population, peaking during Omicron BA.1.
Among 464 infected participants, 7.5% were hospitalized. Hospitalized participants more often reported receiving stronger immunosuppressive regimens (56.8% vs 36.5%) and lung transplant (24.3% vs 9.5%). Hospitalization rates per 100 infections ranged from 14.1 pre-Delta to 2.3 amid BA.2.
The findings can guide counseling regarding the benefits of vaccination, and provide an evidence-based framing of risk and risk behaviors for populations most vulnerable to COVID.
The hospitalization rate was comparable among participants 60 years or older and younger participants (8.3 vs 7.4) but higher in lung than nonlung recipients (18.4 vs 6.6). Of 16 deaths, 5 were related to COVID-19.
The findings "can guide counseling regarding the benefits of vaccination, and provide an evidence-based framing of risk and risk behaviors for populations most vulnerable to COVID, such as transplant patients," senior author William Werbel, MD, PhD, said in a Johns Hopkins news release.