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- Title
Effect of immunosuppression maintenance in solid organ transplant recipients with COVID‐19: Systematic review and meta‐analysis.
- Authors
Karruli, Arta; Spiezia, Serenella; Boccia, Filomena; Gagliardi, Massimo; Patauner, Fabian; Salemme, Anna; Maiello, Ciro; Zampino, Rosa; Durante‐Mangoni, Emanuele
- 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.
- Subjects
COVID-19; TRANSPLANTATION of organs, tissues, etc.; IMMUNOSUPPRESSION; STEROID drugs; TACROLIMUS
- Publication
Transplant Infectious Disease, 2021, Vol 23, Issue 4, p1
- ISSN
1398-2273
- Publication type
Article
- DOI
10.1111/tid.13595