Clinical outcome in solid organ transplant recipients affected by COVID-19 compared to general population: a systematic review and meta-analysis

Gatti, Milo; Rinaldi, Matteo; Bussini, Linda; Bonazzetti, Cecilia; Pascale, Renato; Pasquini, Zeno; Fanì, Francesca; Guedes, Mariana Nunes Pinho; Azzini, Anna Maria; Carrara, Elena; Palacios‐Baena, Zaira R.; Caponcello, Giulia; Reyna‐Villasmil, Eduardo; Tacconelli, Evelina; Rodríguez‐Baño, Jesús; Viale, Pierluigi; Giannella, Maddalena; Caroccia, Natascia; Arbizzani, Federica; Giacomini, Maria Eugenia; Vatamanu, Oana; Razzaboni, Elisa; Rui, Maria Elena De; Górska, Anna M.; Maldonado, Natalia; Olivares, Paula; Gutiérrez-Campos, David; Martín-Gutiérrez, Ana Belén; Palomo, Virginia; Serna, Almudena

doi:10.1016/j.cmi.2022.02.039

Cited by 43 publications

(47 citation statements)

References 49 publications

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“…By multivariate analysis, it was found that none of the variables considered (diabetes, BMI, duration of immunosuppressive treatment, duration of renal disease, and concomitant heart disease) showed a statistically significant impact regardless of the presence or absence of mTOR inhibitors. Furthermore, as reported in the meta-analysis by Gatti et al ( 24 ) also in our case, there was no increased mortality risk in this category of patients compared to the general population.…”

Section: Discussionsupporting

confidence: 87%

mTOR Inhibitor Use Is Associated With a Favorable Outcome of COVID-19 in Patients of Kidney Transplant: Results of a Retrospective Study

et al. 2022

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IntroductionIn solid organ transplant recipients, COVID-19 is associated with a poor prognosis because of immunosuppression. Some studies suggest a potential therapeutic role of mammalian Target of Rapamycin (mTOR) inhibitors in SARS-CoV-2 infection. This study aimed to assess the impact of mTOR employment on the evolution and outcome of SARS-CoV-2 infection in solid organ transplant recipients.MethodsWe enrolled kidney transplant patients attending the Azienda Ospedaliera Universitaria Federico II in Naples and followed up on these patients from March 2020 to June 2021. We evaluated the risk of acquiring the SARS-CoV-2 infection, the clinical presentation of the disease, and its outcome together with the type of immunosuppressive therapy. Finally, we assessed the impact of mTOR inhibitors on relevant clinical metrics of SARS-CoV-2 infection.ResultsWe enrolled 371 patients, of whom 56 (15.1%) contracted SARS-CoV-2 infection during the period of the study. There were no differences observed among the different immunosuppressive therapies concerning the risk of acquiring SARS-CoV-2 infection. In contrast, the type of immunosuppressive therapy had a significant impact on the outcome of the disease. In detail, patients who received mTOR inhibitors, as part of their immunosuppressive therapy, compared to other regimens had a lower chance of developing a moderate or severe form of the disease (OR = 0.8, 95, CI: (0.21–0.92), P = 0.041).ConclusionIn kidney transplant patients, the use of mTOR inhibitors as part of an immunosuppressive regimen is associated with a better prognosis in the case of COVID-19.

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Section: Discussionsupporting

confidence: 87%

mTOR Inhibitor Use Is Associated With a Favorable Outcome of COVID-19 in Patients of Kidney Transplant: Results of a Retrospective Study

et al. 2022

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“…The findings on SOT as a variable with potentially lower odds of hospitalization or death are interesting. Although this was not replicated in the multivariate analysis, it certainly highlights observations from other investigators suggesting that immunosuppressive drugs for solid organ transplant might play an beneficial anti-inflammatory role and that the higher risk of COVID-19 progression in these patients is possibly driven by their other comorbidities, especially diabetes mellitus and cardiovascular disease [ 22 , 23 ]. The recently published retrospective cohort [ 10 ] that evaluated early remdesivir treatment in 24 SOT recipients found results similar to ours regarding lower probability of hospitalization and/or death.…”

Section: Discussionmentioning

confidence: 78%

Early Outpatient Treatment With Remdesivir in Patients at High Risk for Severe COVID-19: A Prospective Cohort Study

Martinez-Guerra

Zalapa-Soto

Román-Montes

et al. 2022

Open Forum Infectious Diseases

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Background Early treatment of COVID-19 with remdesivir in high-risk patients, including those with immunosuppression of different causes has not been evaluated. Objective To assess the clinical effectiveness of early remdesivir treatment among patients with mild to moderate COVID-19 at high risk of progression. Methods This prospective cohort comparative study was conducted in a tertiary referral center in Mexico City. Patients with mild to moderate COVID-19 at high risk for progression were treated with an ambulatory 3-day course of remdesivir. The primary efficacy composite outcome was hospitalization or death at 28 days after symptom onset. Cox proportional hazards regression model was used to identify associations with the primary outcome. Results From December 1st, 2021, to April 30th, 2022, a total of 196 high-risk patients were diagnosed with COVID-19, of which 126 were included in this study (43%, 54/126 received remdesivir, 57%, 72/126 did not receive remdesivir). Baseline clinical characteristics were similar between groups; autoimmune diseases (39/126), solid organ transplant (31/126) and malignant neoplasms (24/126) were the most common immunocompromising conditions. Diabetes mellitus was strongly associated with the primary outcome in both groups. Prior SARS-CoV-2 infection or vaccination were not independently associated with COVID-19 progression. Treatment with remdesivir significantly reduced the odds of hospitalization or death (adjusted HR 0.16 95% CI 0.06 to 0.44, p < 0.01). Conclusion Early outpatient treatment with remdesivir significantly reduces hospitalization or death by 84% in high-risk, majority immunosuppressed patients with COVID-19 Omicron variant.

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“…Immunocompromised patients are at very high risk of developing severe coronavirus disease 2019 (COVID-19), with high morbidity and mortality rates. 1–3 Moreover, low post-vaccinal immune responses have been reported among them, especially in solid organ transplant recipients. 4–6 A number of targeted treatments have been developed to prevent and to cure COVID-19 in at-risk patients, and were recently made available in France.…”

Section: Introductionmentioning

confidence: 99%

Targeted SARS-CoV-2 treatment is associated with decreased mortality in immunocompromised patients with COVID-19

Lafont

Péré

Lebeaux

et al. 2022

Journal of Antimicrobial Chemotherapy

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Background Little is known about targeted (antiviral or monoclonal antibody) anti-SARS-CoV-2 treatment in immunocompromised patients with COVID-19. Objectives To assess the real-life efficacy and tolerance of targeted treatment of COVID-19 in immunocompromised patients. Patients and methods Single-centre retrospective case series of immunocompromised patients with COVID-19 between December 2021 and March 2022. We recorded all cases of COVID-19 among immunocompromised patients treatment between 20 December 2021 and 15 March 2022. Choice of treatment was left to the physician’s decision, according to internal treatment protocol, treatment availability and circulating variants. Main outcome was death from COVID-19 after no treatment or targeted treatment. Results Sixty-seven immunocompromised patients [38 male; median (IQR) age, 53 (43–63) years], with a median (IQR) follow-up of 60 (47–80) days. Ten patients did not receive any targeted treatment. Targeted treatment consisted of IV curative remdesivir (n = 22), sotrovimab (n = 16), tixagevimab/cilgavimab (n = 13) and casirivimab/imdevimab (n = 1). Ten patients (15%) presented severe COVID-19 and 2 (3%) died from Omicron COVID-19. Comparing patients who received targeted anti-SARS-CoV-2 treatment and no prophylaxis, (n = 42; 81%) with those who did not (n = 10; 19%), death rate was significantly lower in treated patients [n = 0 (0%) versus n = 2 (20%); P = 0.034]. No severe adverse events were reported among treated patients. Among 15 patients who received tixagevimab/cilgavimab as pre-exposure prophylaxis, 6 received an additional curative treatment and none died from COVID-19. Conclusions Our results suggest that targeted COVID-19 treatment, including direct antivirals or monoclonal antibodies, is safe and efficient and could be proposed in high-risk immunocompromised patients.

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Clinical outcome in solid organ transplant recipients affected by COVID-19 compared to general population: a systematic review and meta-analysis

Cited by 43 publications

References 49 publications

mTOR Inhibitor Use Is Associated With a Favorable Outcome of COVID-19 in Patients of Kidney Transplant: Results of a Retrospective Study

mTOR Inhibitor Use Is Associated With a Favorable Outcome of COVID-19 in Patients of Kidney Transplant: Results of a Retrospective Study

Early Outpatient Treatment With Remdesivir in Patients at High Risk for Severe COVID-19: A Prospective Cohort Study

Targeted SARS-CoV-2 treatment is associated with decreased mortality in immunocompromised patients with COVID-19

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