Clinical Presentations and Outcomes in Transplant Patients With COVID-19: A Systematic Review and Meta-Analysis

Abbas, Kirellos Shah Jaffer El-Sahat Nahla Ali Fatmaelzahraa Mostafa Esraa Khattab Ebrahem Sherif Hadeer Djedid Selma Klouche Elmamoun Yousra Abdhalim Nada Gayed Ramy Amin Mostafa Lama Nitu Alahmar Majd Mohamed Zeinab Dabbous Shrouk Phuong Nguyen Brown Ashlyn Varney Joseph Huy Nguyen

Introduction: Transplant patients are a vulnerable group due to their immunocompromised status. Understanding how COVID-19 can present in this group is clinically important. Therefore, we conduct a systematic review and meta-analysis on clinical features and management of transplant patients with COVID-19. Methods: Five databases were searched in May 2020 to include all relevant studies reporting clinical features or outcomes of COVID-19 infection in transplant patients. Data on clinical presentation, outcomes, lab values, imaging, and drug regimen were extracted. CMA software was used for meta-analysis. Protocol was registered in PROSPERO (CRD42020189458). Results: A total of 49 studies were finally included for analysis. Patients mainly complained from fever with event rate 74.40 % (95% CI= 69.4-78.8), cough 61.10% (95% CI= 55.8-66), and dyspnea 46.60% (95% CI= 69.4-78.8). Blood urea nitrogen 78.90% (95% CI= 54.7-92), ESR 78.10% (95% CI=52.3-92.1), and D-dimer 74.10% (95 % CI= 53-87.9) were the most elevated observed laboratory values. Ground glass opacities (GGO) were observed with event rate 68.10% (95% CI= 20.4-94.9). For treatment, immunosuppressants were used in 88.80% (95% CI= 77.6-94.8) of patients, followed by antibiotics and antiviral drugs 68.40% (95% CI= 52.4-80.9), 66.80% (95% CI = 45-83.2), respectively. Mechanical ventilation was used in 26.30% (95% CI=21-32.4) patients while 33.7% (95% CI= 20.7-49.9) intubated. Rejection occurred in 11% (95% CI= 4.4-25) of the patients. Finally, 18.20% (95% CI= 12.6-25.7) died. Conclusion: Clinical characteristics and management in transplant COVID patients suggest the similar course in non-transplant. Fever, cough, dyspnoea, elevated blood urea nitrogen level, elevated CRP, elevated d-dimer, GGO, and consolidation were found to be the most frequent abnormalities. No direct, comparative analysis with non-transplant COVID population limited our results;however, numerous studies that examined the infected general population found similar, less augmented findings. Most of the included sample were kidney transplant patients;therefore, more studies are needed to address other types of COVID-19 infected transplant patients.