Hormone Replacement Therapy and COVID-19 Outcomes in Solid Organ Transplant Recipients Compared with the General Population

Amanda J. Vinson; Alfred Anzalone; Makayla Schissel; Ran Dai; Evan T. French; Amy L. Olex; Roslyn B. Mannon; National COVID Cohort Collaborative

doi:10.1016/j.ajt.2023.04.020

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Hormone Replacement Therapy and COVID-19 Outcomes in Solid Organ Transplant Recipients Compared with the General Population

Journal article

Open access

Peer reviewed

Hormone Replacement Therapy and COVID-19 Outcomes in Solid Organ Transplant Recipients Compared with the General Population

Amanda J. Vinson, Alfred Anzalone, Makayla Schissel, Ran Dai, Evan T. French, Amy L. Olex, Roslyn B. Mannon and National COVID Cohort Collaborative

American journal of transplantation, Vol.23(7), pp.1035-1047

07/01/2023

DOI: 10.1016/j.ajt.2023.04.020

PMCID: PMC10129906

PMID: 37105315

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Abstract

Exogenous estrogen is associated with reduced COVID mortality in non-immunosuppressed/immunocompromised (non-ISC) post-menopausal females. Here, we examined the association of estrogen or testosterone hormone replacement therapy (HRT) with COVID outcomes in solid organ transplant recipients (SOTR) compared to non-ISC individuals, given known differences in sex-based risk in these populations. SOTR >45y with COVID-19 between 04-01-2020 and 07-31-2022 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 (MARCE) 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 1,135 SOTR and 43,383 immunocompetent patients on HRT with COVID-19. In non-ISC, HRT use was associated with lower risk of MARCE (aHR 0.61, 95% CI 0.57-0.65 for females; aHR 0.70, 0.65-0.77 for males), and all secondary outcomes. In SOTR, HRT reduced the risk of AKI (aHR 0.79, 0.63-0.98) and mortality (aHR 0.49, 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.

androgens

COVID-19

estrogens

exogenous hormones

hormone replacement therapy

immunity

infection

Original

SARS-CoV-2

sex

Transplantation

Details

Title: Subtitle: Hormone Replacement Therapy and COVID-19 Outcomes in Solid Organ Transplant Recipients Compared with the General Population
Creators: Amanda J. Vinson - Dalhousie University
Alfred Anzalone - University of Nebraska Medical Center
Makayla Schissel - University of Nebraska Medical Center
Ran Dai - University of Nebraska Medical Center
Evan T. French - Virginia Commonwealth University
Amy L. Olex - Virginia Commonwealth University
Roslyn B. Mannon - University of Nebraska Medical Center
National COVID Cohort Collaborative
Contributors: Charisse R Madlock-Brown (Contributor) - University of Iowa, Nursing
Resource Type: Journal article
Publication Details: American journal of transplantation, Vol.23(7), pp.1035-1047
DOI: 10.1016/j.ajt.2023.04.020
PMID: 37105315
PMCID: PMC10129906
NLM abbreviation: Am J Transplant
ISSN: 1600-6135
eISSN: 1600-6143
Publisher: American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc
Language: English
Date published: 07/01/2023
Academic Unit: Nursing
Record Identifier: 9984446740302771

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