Mortality in organ transplant recipients with COVID-19 compared to non-transplant or waitlisted patients: A meta-analysis

ABSTRACT

Purpose: Organ transplant recipients (OTR) are considered at high risk for adverse outcomes from COVID-19. However, mortality rates range from <5% to >30%. Some studies found that OTR have comparable outcomes with non-transplant patients, whereas other investigators reported higher mortality rates. To our knowledge, there are no published meta-analyses comparing outcomes between OTR and nontransplant patients with COVID-19. Methods: Two independent abstractors conducted a systematic search of PUBMED and EMBASE databases, references of articles retrieved, and major transplantation journals. We included studies published between 12/1/19 and 2/11/21, and performed a study-level random-effects meta-analysis with pooling of all-cause mortality, comparing separately OTR with non-transplant and waitlisted patients. Results: We included 26 studies with a total of 3,331 OTR. 83% were kidney, 8% liver, 6% heart and 3% lung transplant recipients. 66.3% were men. OTR had higher mortality compared to controls, however the difference did not reach statistical significance, and heterogeneity was high (Fig. 1). When analyzing studies evaluating OTR and controls that were matched for potential confounders, the difference in mortality was statistically significant, with a marked decrease in heterogeneity and risk of publication bias (Fig. 2). OTR did not have significantly higher mortality compared to waitlisted patients, but, again, heterogeneity was high (Fig. 3). Conclusions: OTR with COVID-19 seem to have higher mortality rates compared to immunocompetent individuals, but not waitlisted patients. OTR should be considered a high priority group for preventive and therapeutic interventions.