*Communication* **COVID-19 Severity and Mortality in Solid Organ Transplantation: Differences between Liver, Heart, and Kidney Recipients**

**Ricardo Wesley Alberca \*, Gabriela Gama Freire Alberca, Lucas Chaves Netto, Raquel Leão Orfali, Sarah Cristina Gozzi-Silva, Alberto José da Silva Duarte, Valeria Aoki, Maria Notomi Sato and Gil Benard**

> Laboratório de Dermatologia e Imunodeficiências (LIM-56), Departamento de Dermatologia, Faculdade de Medicina FMUSP, Instituto de Medicina Tropical da Universidade de São Paulo, São Paulo 05403-000, SP, Brazil; gabrielafreire@alumni.usp.br (G.G.F.A.); lucaschaves92@gmail.com (L.C.N.); raquel.orfali@fm.usp.br (R.L.O.); sarahgozzi@usp.br (S.C.G.-S.); adjsduar@usp.br (A.J.d.S.D.); valeria.aoki@usp.br (V.A.); marisato@usp.br (M.N.S.); mahong@usp.br (G.B.)

**\*** Correspondence: ricardowesley@usp.br; Tel.: +55-(11)-3061-7011

**Abstract:** The infection by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can generate a wide spectrum of clinical manifestations ranging from asymptomatic to severe respiratory and systemic disease with coagulation disorder named coronavirus disease 2019 (COVID-19). Patients with comorbidities have been identified as risk groups for severe COVID-19, also having a higher death risk. Previous reports have conflicting results regarding if solid organ transplant recipients present an increased risk for COVID-19. Nevertheless, previous investigations failed to distinguish between different organs received or made a longitudinal investigation on those patients. We recruited 39 solid organ transplant recipients: 25 kidney transplant recipients, 7 heart transplant recipients, and 7 liver transplant recipients and 25 age-matched non-transplant COVID-19 patients without comorbidities (control group) and compared daily laboratory data in addition to performing survival analysis. Heart and kidney transplant recipients presented an increase in several COVID-19 severity-associated biomarkers, such as neutrophil-to-lymphocyte ratio and thrombocytopenia, in comparison to the control group and liver transplant recipients. Heart and kidney transplant recipients also presented an increase in the need for intensive care and invasive mechanical ventilation during the disease's course. Importantly, heart and kidney transplant recipients presented a higher mortality rate in comparison to liver transplant recipients and non-transplant recipients. In our cohort, heart and kidney transplant recipients presented a difference in clinical characteristics and survival rate in comparison to liver transplant recipients. Further investigation involving immune response to SARS-CoV-2 in solid organ recipients should consider and separate patients according to the organ grafted.

**Keywords:** transplant recipients; COVID-19; SARS-CoV-2; inflammation; survival
