Hormone replacement therapy and COVID-19 outcomes in solid organ transplant recipients compared with the general population

the National COVID Cohort Collaborative

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Exogenous estrogen is associated with reduced coronavirus disease (COVID) mortality in nonimmunosuppressed/immunocompromised (non-ISC) postmenopausal females. Here, we examined the association of estrogen or testosterone hormone replacement therapy (HRT) with COVID outcomes in solid organ transplant recipients (SOTRs) compared to non-ISC individuals, given known differences in sex-based risk in these populations. SOTRs ≥45 years old with COVID-19 between April 1, 2020 and July 31, 2022 were identified using the National COVID Cohort Collaborative. The association of HRT use in the last 24 months (exogenous systemic estrogens for females; testosterone for males) with major adverse renal or cardiac events in the 90 days post-COVID diagnosis and other secondary outcomes were examined using multivariable Cox proportional hazards models and logistic regression. We repeated these analyses in a non-ISC control group for comparison. Our study included 1135 SOTRs and 43 383 immunocompetent patients on HRT with COVID-19. In non-ISC, HRT use was associated with lower risk of major adverse renal or cardiac events (adjusted hazard ratio [aHR], 0.61; 95% confidence interval [CI], 0.57-0.65 for females; aHR, 0.70; 95% CI, 0.65-0.77 for males) and all secondary outcomes. In SOTR, HRT reduced the risk of acute kidney injury (aHR, 0.79; 95% CI, 0.63-0.98) and mortality (aHR, 0.49; 95% CI, 0.28-0.85) in males with COVID but not in females. The potentially modifying effects of immunosuppression on the benefits of HRT requires further investigation.

Original languageEnglish (US)
Pages (from-to)1035-1047
Number of pages13
JournalAmerican Journal of Transplantation
Volume23
Issue number7
DOIs
StatePublished - Jul 2023

Bibliographical note

Publisher Copyright:
© 2023 American Society of Transplantation & American Society of Transplant Surgeons

Keywords

  • COVID-19
  • SARS-CoV-2
  • androgens
  • estrogens
  • exogenous hormones
  • hormone replacement therapy
  • immunity
  • infection
  • sex
  • transplantation

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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