TY - JOUR
T1 - Hormone replacement therapy and COVID-19 outcomes in solid organ transplant recipients compared with the general population
AU - the National COVID Cohort Collaborative
AU - Vinson, Amanda J.
AU - Anzalone, Alfred
AU - Schissel, Makayla
AU - Dai, Ran
AU - French, Evan T.
AU - Olex, Amy L.
AU - Mannon, Roslyn B.
AU - Wilcox, Adam B.
AU - Lee, Adam M.
AU - Graves, Alexis
AU - Anzalone, Alfred (Jerrod)
AU - Manna, Amin
AU - Saha, Amit
AU - Olex, Amy
AU - Zhou, Andrea
AU - Williams, Andrew E.
AU - Southerland, Andrew
AU - Girvin, Andrew T.
AU - Walden, Anita
AU - Sharathkumar, Anjali A.
AU - Amor, Benjamin
AU - Bates, Benjamin
AU - Hendricks, Brian
AU - Patel, Brijesh
AU - Alexander, Caleb
AU - Bramante, Carolyn
AU - Ward-Caviness, Cavin
AU - Madlock-Brown, Charisse
AU - Suver, Christine
AU - Chute, Christopher
AU - Dillon, Christopher
AU - Wu, Chunlei
AU - Schmitt, Clare
AU - Takemoto, Cliff
AU - Housman, Dan
AU - Gabriel, Davera
AU - Eichmann, David A.
AU - Mazzotti, Diego
AU - Brown, Don
AU - Boudreau, Eilis
AU - Hill, Elaine
AU - Zampino, Elizabeth
AU - Marti, Emily Carlson
AU - Pfaff, Emily R.
AU - French, Evan
AU - Koraishy, Farrukh M.
AU - Mariona, Federico
AU - Prior, Fred
AU - Chapman, Scott
AU - Johnson, Steve
N1 - Publisher Copyright:
© 2023 American Society of Transplantation & American Society of Transplant Surgeons
PY - 2023/7
Y1 - 2023/7
N2 - 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.
AB - 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.
KW - COVID-19
KW - SARS-CoV-2
KW - androgens
KW - estrogens
KW - exogenous hormones
KW - hormone replacement therapy
KW - immunity
KW - infection
KW - sex
KW - transplantation
UR - http://www.scopus.com/inward/record.url?scp=85158821559&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85158821559&partnerID=8YFLogxK
U2 - 10.1016/j.ajt.2023.04.020
DO - 10.1016/j.ajt.2023.04.020
M3 - Article
C2 - 37105315
AN - SCOPUS:85158821559
SN - 1600-6135
VL - 23
SP - 1035
EP - 1047
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 7
ER -