*Article* **SARS-CoV-2 Infection of Unvaccinated Liver- and Kidney-Transplant Recipients: A Single-Center Experience of 103 Consecutive Cases**

**Hailey Hardgrave 1,2, Allison Wells 2,3, Joseph Nigh 2,3, Tamara Osborn 2, Garrett Klutts 2, Derek Krinock 2, Mary Katherine Rude 4, Sushma Bhusal 5, Lyle Burdine 2,3 and Emmanouil Giorgakis 2,3,\***


**Abstract:** Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) was declared a pandemic in March 2020. Its reported impact on solid-organ-transplant-recipient morbidity and mortality has varied. The aim of this study was to present the effect of transplant status, patient comorbidities and immunosuppression modality on the survival of solid-organ-transplant recipients who contracted SAR-CoV-2 during the pre-vaccination era, at a single academic transplant center. Patients (n = 103) were assessed for 90-day mortality. A univariate analysis identified an age of over 60 years (HR = 10, *p* = 0.0034), Belatacept (HR = 6.1, *p* = 0.022), and Cyclosporine (HR = 6.1, *p* = 0.0089) as significant mortality risk factors; Tacrolimus was protective (HR = 0.23, *p* = 0.022). Common metabolic comorbidities (hypertension, diabetes, obesity) did not stand out as risk factors in our patient cohort. This study on the unvaccinated is expected to facilitate a paired comparison of outcomes in transplanted patients who contracted SARS-CoV-2 during the latter period of the pandemic, when broad SARS-CoV-2 vaccination and novel antibody treatments became broadly available.

**Keywords:** solid-organ transplant; COVID-19; unvaccinated; immunosuppression
