Population-based studies evaluating prevalence of postacute sequelae following coronavirus diseases 2019 (COVID-19), or long-COVID-19, in transplant recipients are limited. We examined the risk of long-COVID-19 following severe-acute-respiratory-syndrome-coronavirus-2 (SARS-CoV-2) infection with the Omicron variant, in a retrospective population-based cohort of transplant recipients vs test-negatives. National COVID-19/health care claims databases were used to construct cohorts of all Singaporean adult transplant recipients infected during Omicron predominance (January 1-December 31, 2022) and contemporaneous test-negatives. Competing-risks regression (death as a competing risk), with overlap weights applied, was used to estimate risks of new-incident diagnoses/symptoms 31 to 300 days post-SARS-CoV-2 infection in transplant recipients vs test-negatives. A total of 1890 SARS-CoV-2-infected transplant recipients and 1482 test-negatives were included. In total, 88.7% were boosted. Overall risks of postacute sequelae were not significantly increased in SARS-CoV-2-infected transplant recipients vs test-negatives (any postacute diagnosis: adjusted hazard ratio [aHR] = 1.35 [95% confidence interval {CI}, = 0.74-2.45]; any postacute symptom: aHR = 1.06 [95% CI = 0.52-2.17]). However, increased risk of postacute autoimmune (aHR = 5.34 [95% CI = 1.03-27.62])/neurologic sequelae (aHR = 3.06 [95% CI = 1.23-7.61]) was observed in SARS-CoV-2-infected transplant recipients vs test-negatives, though excess burden was modest (autoimmune: excess burden per 1000 individuals = 5.58 [95% CI = -4.49 to 15.65]; neurologic: excess burden per 1000 individuals = 19.82 [95% CI = -4.33 to 43.96]). Risks of postacute neurologic/autoimmune sequelae remained elevated in untreated COVID-19 cases vs test-negatives but did not significantly differ in treated COVID-19 cases vs test-negatives. We concluded that the overall risk of postacute sequelae was not significantly elevated in a highly vaccinated/boosted cohort of Omicron SARS-CoV-2-infected transplant recipients vs test-negatives. COVID-19 vaccination/boosting remains important during endemicity.
