Clinical outcome in solid organ transplant recipients affected by COVID-19 compared to general population: a systematic review and meta-analysis

• Published in: Clinical microbiology and infection Vol. 28; no. 8; pp. 1057 - 1065
• Main Authors: Gatti, Milo, Rinaldi, Matteo, Bussini, Linda, Bonazzetti, Cecilia, Pascale, Renato, Pasquini, Zeno, Faní, Francesca, Pinho Guedes, Mariana Nunes, Azzini, Anna Maria, Carrara, Elena, Palacios-Baena, Zaira R., Caponcello, Giulia, Reyna-Villasmil, Eduardo, Tacconelli, Evelina, Rodríguez-Baño, Jesús, Viale, Pierluigi, Giannella, Maddalena, Caroccia, Natascia, Arbizzani, Federica, Giacomini, Maria Eugenia, Vatamanu, Oana, Razzaboni, Elisa, De Rui, Maria Elena, Gorska, Anna, Maldonado, Natalia, Olivares, Paula, Gutiérrez-Campos, David, Martín-Gutiérrez, Ana Belén, Palomo, Virginia, Serna, Almudena
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-08-2022; European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd
• Subjects: 30-Day mortality rate; Clinical outcome; COVID-19; COVID-19 - epidemiology; Humans; Organ Transplantation - adverse effects; Prospective Studies; Retrospective Studies; Solid organ transplant recipients; Superinfections; Systematic Review; Transplant Recipients; COVID-19; Clinical outcome; Superinfections; 30-Day mortality rate; Solid organ transplant recipients
• ISSN: 1198-743X; 1469-0691; 1469-0691
• DOI: 10.1016/j.cmi.2022.02.039

A significant increased risk of complications and mortality in immunocompromised patients affected by COVID-19 has been described. However, the impact of COVID-19 in solid organ transplant (SOT) recipients is an issue still under debate, due to conflicting evidence that has emerged from different observational studies.
We performed a systematic review with a meta-analysis to assess the clinical outcome in SOT recipients with COVID-19 compared with the general population.
PubMed-MEDLINE and Scopus were independently searched until 13 October 2021.
Prospective or retrospective observational studies comparing clinical outcome in SOT recipients versus general populations affected by COVID-19 were included. The primary endpoint was 30-day mortality.
Participants were patients with confirmed COVID-19.
Interventions reviewed were SOTs.
The quality of the included studies was independently assessed with the Risk of Bias in Non-randomized Studies of Interventions tool for observational studies. The meta-analysis was performed by pooling ORs retrieved from studies providing adjustment for confounders using a random-effects model with the inverse variance method. Multiple subgroups and sensitivity analyses were conducted to investigate the source of heterogeneity.
A total of 3501 articles were screened, and 31 observational studies (N = 590 375; 5759 SOT recipients vs. 584 616 general population) were included in the meta-analyses. No difference in 30-day mortality rate was found in the primary analysis, including studies providing adjustment for confounders (N = 17; 3752 SOT recipients vs. 159 745 general population; OR: 1.13; 95% CI, 0.94–1.35; I2 = 33.9%). No evidence of publication bias was reported. A higher risk of intensive care unit admission (OR: 1.56; 95% CI, 1.03–2.63) and occurrence of acute kidney injury (OR: 2.50; 95% CI, 1.81–3.45) was found in SOT recipients.
No increased risk in mortality was found in SOT recipients affected by COVID-19 compared with the general population when adjusted for demographic and clinical features and COVID-19 severity.