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Abstract: TH-PO943

Hormone Replacement Therapy and COVID-19 Outcomes in Kidney Transplant Recipients Compared With the General Population

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)


  • Vinson, Amanda Jean, Dalhousie University, Halifax, Nova Scotia, Canada
  • Anzalone, Alfred J., University of Nebraska Medical Center, Omaha, Nebraska, United States
  • Schissel, Makayla, University of Nebraska Medical Center, Omaha, Nebraska, United States
  • French, Evan T., Virginia Commonwealth University, Richmond, Virginia, United States
  • Olex, Amy L., Virginia Commonwealth University, Richmond, Virginia, United States
  • Mannon, Roslyn B., University of Nebraska Medical Center, Omaha, Nebraska, United States

Group or Team Name

  • National Covid Cohort Collaborative (N3C)

In the non-immunosuppressed (non-IS) population, female sex is protective against adverse COVID-19 (C19) outcomes, possibly due to estrogen-related immunity. Sex-based risk is attenuated in IS kidney transplant recipients (KTRs). Exogenous estrogen is associated with reduced C19 mortality in non-IS post-menopausal females. Here, we aimed to study the impact of estrogen or testosterone hormone replacement therapy (HRT) on C19 outcomes in KTRs compared to the general population.


We studied adult (>45 yrs) KTRs from across the US with C19 from 05-01-20 to 05-12-22, using EHR data from the National COVID Cohort Collaborative. Female and male patients were classified as no HRT, or HRT use in the last 6 months (exogenous systemic estrogens for females; testosterone for males). Using MV cox proportional hazards models and logistic regression, we determined the risk of developing a major adverse renal or cardiac event (MARCE), mortality, and other 90-day post-C19 outcomes. We repeated this analysis in a non-IS control group for comparison.


Over the study period, 11,498 KTRs and >1.9M non-IS patients were diagnosed with C19. In non-IS, relative to no HRT use, HRT use in the last 6 months was associated with significantly lower risk of MARCE (Hazard Ratio [HR] 0.54, 95% Confidence Interval [CI] 0.51-0.59, for females; 0.63, 0.56-0.70, for males), mortality (HR 0.45, CI 0.40-0.51, for females; 0.55, 0.45-0.66, for males), and all secondary events for males and females (Figure 1). In KTRs, HRT was not associated with any post-C19 outcome in either males or females; there was a trend towards lower risk in males on HRT vs not on HRT, for most outcomes.


HRT was protective against adverse C19 outcomes in older non-IS males and females, but not in KTRs. The modifying effects of IS on the benefits of HRT requires further investigation.


  • Other NIH Support