*4.12. Hospital Admission Rate*

The clinical spectrum of COVID-19 in LTRs is broad, ranging from mild infection of the upper respiratory tract to severe acute respiratory distress syndrome with multiorgan failure and death as demonstrated here in this single center case series. The impact of maintenance immunosuppression in LTRs on COVID-19 severity, remains to be defined.

In our case series, 67% (n = 12) of patients with COVID-19 were hospitalized. One meta-analysis, studying the hospital admission rate in solid organ transplant recipients with COVID-19, showed that the hospital admission rate in these patients is significantly higher (81%) as compared to the general population [57]. However, the higher admission rates may rather reflect the defensive treatment strategy in these vulnerable patients, in whom careful clinical monitoring in a hospital setting is preferred since the respiratory deterioration in COVID-19 patients frequently is rapid and escalation of therapy is easiest in the hospital setting. In some instances, when patients fear COVID-19 deterioration, they might prefer inpatient treatment and monitoring, but sometimes also the opposite can be seen when patients fear hospitalization due to COVID-19 related overcrowding of hospitals with limited resources or they fear contracting COVID-19 in the hospital setting. The latter has been observed frequently during the early phases of the pandemic, with a general avoidance of the hospitals due to accumulation of severe cases. It should also be mentioned that studies comparing these admission rates are difficult to compare due to differences in comorbidities in LTRs compared to the general population.
