Author: Karruli, Arta; Spiezia, Serenella; Boccia, Filomena; Gagliardi, Massimo; Patauner, Fabian; Salemme, Anna; Maiello, Ciro; Zampino, Rosa; Duranteâ€Mangoni, Emanuele
Title: Effect of immunosuppression maintenance in solid organ transplant recipients with COVIDâ€19: Systematic review and metaâ€analysis Cord-id: x7xh8jwb Document date: 2021_3_18
ID: x7xh8jwb
Snippet: 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 (COVIDâ€19). METHODS: Systematic review and metaâ€analysis of data on 202 SOTR with COVIDâ€19, published as case reports or case series. We extracted clinical, hematoâ€chemical, imaging, treatment, and outcome data. RESULTS: Most patients were kidney recipients (61.9%), males (68.8%), with median age of 57 years. The maj
Document: 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 (COVIDâ€19). METHODS: Systematic review and metaâ€analysis of data on 202 SOTR with COVIDâ€19, published as case reports or case series. We extracted clinical, hematoâ€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 COVIDâ€19 disease. Age (OR 1.07, 95% CI 1â€1.11, P = .001) and lopinavir/ritonavir use (OR 3.3, 95%CI 1.2â€8.5, P = .013) were independent predictors of mortality while immunosuppression maintenance (OR 0.067, 95% CI 0.008â€0.558, P = .012) and tacrolimus continuation (OR 0.3, 95% CI 0.1â€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 COVIDâ€19. Specifically, receiving tacrolimus could be beneficial for COVIDâ€19 SOTR. Because of the quality of the available evidence, no definitive guidance on how to manage SOTR with COVIDâ€19 can be derived from our data.
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