Article ; Online: Effect of immunosuppression maintenance in solid organ transplant recipients with COVID-19: Systematic review and meta-analysis.
Transplant infectious disease : an official journal of the Transplantation Society
2021 Volume 23, Issue 4, Page(s) e13595
Abstract: ... therapy in solid organ transplant recipients (SOTR) with coronavirus disease 2019 (COVID-19).: Methods ... Systematic review and meta-analysis of data on 202 SOTR with COVID-19, published as case reports or case ... immune suppression might be safe in SOTR with moderate and severe COVID-19. Specifically, receiving tacrolimus ...
| Abstract | Background: The aim of this study was to assess the effect of continuing immune suppressive therapy in solid organ transplant recipients (SOTR) with coronavirus disease 2019 (COVID-19). Methods: Systematic review and meta-analysis of data on 202 SOTR with COVID-19, published as case reports or case series. We extracted clinical, hemato-chemical, imaging, treatment, and outcome data. Results: Most patients were kidney recipients (61.9%), males (68.8%), with median age of 57 years. The majority was on tacrolimus (73.5%) and mycophenolate (65.8%). Mortality was 18.8%, but an equal proportion was still hospitalized at last follow up. Immune suppressive therapy was withheld in 77.2% of patients, either partially or completely. Tacrolimus was continued in 50%. One third of survivors that continued immunosuppressants were on dual therapy plus steroids. None of those who continued immunosuppressants developed critical COVID-19 disease. Age (OR 1.07, 95% CI 1-1.11, P = .001) and lopinavir/ritonavir use (OR 3.3, 95%CI 1.2-8.5, P = .013) were independent predictors of mortality while immunosuppression maintenance (OR 0.067, 95% CI 0.008-0.558, P = .012) and tacrolimus continuation (OR 0.3, 95% CI 0.1-0.7, P = .013) were independent predictors of survival. Conclusions: Our data suggest that maintaining immune suppression might be safe in SOTR with moderate and severe COVID-19. Specifically, receiving tacrolimus could be beneficial for COVID-19 SOTR. Because of the quality of the available evidence, no definitive guidance on how to manage SOTR with COVID-19 can be derived from our data. |
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| MeSH term(s) | COVID-19 ; Graft Rejection ; Humans ; Immunosuppression Therapy/adverse effects ; Immunosuppressive Agents/adverse effects ; Male ; Middle Aged ; Organ Transplantation/adverse effects ; SARS-CoV-2 ; Transplant Recipients | |||||
| Chemical Substances | Immunosuppressive Agents | |||||
| Language | English | |||||
| Publishing date | 2021-03-18 | |||||
| Publishing country | Denmark | |||||
| Document type | Journal Article ; Meta-Analysis ; Systematic Review | |||||
| ZDB-ID | 1476094-0 | |||||
| ISSN | 1399-3062 ; 1398-2273 | |||||
| ISSN (online) | 1399-3062 | |||||
| ISSN | 1398-2273 | |||||
| DOI | 10.1111/tid.13595 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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