Mortality, risk factors, and treatment of COVID-19 infection in solid organ transplants: A systematic review and meta-analysis

ABSTRACT

Purpose: Outcomes for solid organ transplants (SOT) with COVID-19 have not been summarized, and prognostic factors for COVID-19 in SOT patients are not well established yet. Methods: We searched PubMed, EMBASE, and Cochrane library up to November 10, 2020, to identify reports of SOT patients and COVID-19. This study was performed to estimate the risk of death and other important outcomes. Further, we also evaluated the risk factors associated with mortality and severe COVID-19 infection in SOT patients. Pooled prevalence, odds ratios (OR), and 95% confidence intervals (CI) were calculated using a random-effects model. Results: Fifty-nine studies involving 7071 SOT patients were included. 22% of SOT patients with COVID-19 were dead (20%-25%), 48% had acute kidney injury, 39% developed severe infection, 28% needed intensive care unit (ICU) admission, 35% had acute respiratory distress syndrome, and 23% needed invasive ventilation. Univariate analysis revealed that advanced age (OR=3.01, OR=2.97), obesity (OR=1.44, OR=2.05) and diabetes (OR=2.00, OR=1.73) were associated with severe infection and mortality. Laboratory abnormalities at admission including higher C reaction protein, D-Dimer, lactate dehydrogenase, procalcitonin, and lower lymphocyte also increased the risk of death. Initial MMF use (OR=1.61) contributed to severe infection, and tacrolimus (OR=1.70) led to more deaths. Further, calcinurin inhibitors withdrawal (OR=2.62), high dose steroids (OR=2.46), Tocilizumab (OR=1.75), ICU admission (OR=5.00), and invasive ventilation (OR=7.56) were associated with mortality. Conclusions: Our study demonstrated that SOT patients with COVID-19 had a high mortality and risk factors identification may contribute to patients stratification and management.