Hormone replacement therapy and COVID-19 outcomes in solid organ transplant recipients compared with the general population.

In non-immunosuppressed/immunocompromised individuals, female HRT use was associated with lower risk of major adverse renal or cardiac events following COVID-19 diagnosis.

• Adjusted hazard ratio of 0.61 (95% CI, 0.57-0.65) for females on HRT in non-ISC group
• Outcome measured was major adverse renal or cardiac events in the 90 days post-COVID diagnosis
• HRT defined as exogenous systemic estrogens used in the last 24 months
• Analysis used multivariable Cox proportional hazards models
• Non-ISC group included 43,383 immunocompetent patients on HRT with COVID-19

In non-immunosuppressed/immunocompromised individuals, male HRT use was associated with lower risk of major adverse renal or cardiac events following COVID-19 diagnosis.

• Adjusted hazard ratio of 0.70 (95% CI, 0.65-0.77) for males on HRT in non-ISC group
• HRT for males was defined as testosterone use in the last 24 months
• Association extended to all secondary outcomes examined
• Patients were aged 45 years or older with COVID-19 between April 1, 2020 and July 31, 2022

In male solid organ transplant recipients, testosterone HRT was associated with reduced risk of acute kidney injury following COVID-19.

• Adjusted hazard ratio of 0.79 (95% CI, 0.63-0.98) for acute kidney injury in male SOTRs on HRT
• The SOTR cohort included 1,135 solid organ transplant recipients with COVID-19
• Confidence interval just excludes 1.0, indicating statistical significance
• Outcome measured within 90 days post-COVID diagnosis

In male solid organ transplant recipients, testosterone HRT was associated with reduced mortality following COVID-19.

• Adjusted hazard ratio of 0.49 (95% CI, 0.28-0.85) for mortality in male SOTRs on HRT
• This represents approximately a 51% reduction in mortality risk
• Analysis performed using multivariable Cox proportional hazards models
• Protective effect was not observed in female SOTRs

HRT was not associated with reduced COVID-19 outcomes in female solid organ transplant recipients.

• No statistically significant protective association was found for estrogen HRT in female SOTRs for major adverse renal or cardiac events or other secondary outcomes
• This contrasts with the significant protective effect seen in non-ISC females (aHR 0.61)
• The study population included SOTRs aged ≥45 years with COVID-19 identified from the National COVID Cohort Collaborative
• Authors conclude that immunosuppression may potentially modify the benefits of HRT in females

The study used the National COVID Cohort Collaborative to identify solid organ transplant recipients and non-immunosuppressed/immunocompromised comparators with COVID-19.

• SOTRs were aged ≥45 years with COVID-19 between April 1, 2020 and July 31, 2022
• Total study included 1,135 SOTRs and 43,383 immunocompetent patients on HRT with COVID-19
• HRT exposure was defined as use in the last 24 months prior to COVID-19 diagnosis
• Exogenous systemic estrogens were used as HRT definition for females; testosterone for males
• Multivariable Cox proportional hazards models and logistic regression were used for analysis