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Effect of immunosuppression maintenance in solid organ transplant recipients with COVID-19: Systematic review and meta-analysis.
Karruli, Arta; Spiezia, Serenella; Boccia, Filomena; Gagliardi, Massimo; Patauner, Fabian; Salemme, Anna; Maiello, Ciro; Zampino, Rosa; Durante-Mangoni, Emanuele.
  • Karruli A; Division of Internal Medicine, University of Campania 'L. Vanvitelli', Naples, Italy.
  • Spiezia S; Division of Internal Medicine, University of Campania 'L. Vanvitelli', Naples, Italy.
  • Boccia F; Division of Internal Medicine, University of Campania 'L. Vanvitelli', Naples, Italy.
  • Gagliardi M; Division of Internal Medicine, University of Campania 'L. Vanvitelli', Naples, Italy.
  • Patauner F; Division of Internal Medicine, University of Campania 'L. Vanvitelli', Naples, Italy.
  • Salemme A; Division of Internal Medicine, University of Campania 'L. Vanvitelli', Naples, Italy.
  • Maiello C; Unit of Cardiac Surgery and Transplants, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy.
  • Zampino R; Division of Internal Medicine, University of Campania 'L. Vanvitelli', Naples, Italy.
  • Durante-Mangoni E; Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy.
Transpl Infect Dis ; 23(4): e13595, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1145347
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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Full text: Available Collection: International databases Database: MEDLINE Main subject: Organ Transplantation / COVID-19 Type of study: Cohort study / Experimental Studies / Prognostic study / Reviews / Systematic review/Meta Analysis Limits: Humans / Male / Middle aged Language: English Journal: Transpl Infect Dis Journal subject: Transplantation Year: 2021 Document Type: Article Affiliation country: Tid.13595

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Organ Transplantation / COVID-19 Type of study: Cohort study / Experimental Studies / Prognostic study / Reviews / Systematic review/Meta Analysis Limits: Humans / Male / Middle aged Language: English Journal: Transpl Infect Dis Journal subject: Transplantation Year: 2021 Document Type: Article Affiliation country: Tid.13595