Effect of immunosuppression maintenance in solid organ transplant recipients with COVID‐19: Systematic review and meta‐analysis

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.

COVID-19 in Solid Organ Transplant Recipients in Spain Throughout 2020: Catching the Wave?

“…In a recently published systematic review and meta-analysis, maintaining immunosuppression was concluded to be safe in SOT recipients with moderate or severe COVID-19, and continuing tacrolimus was suggested to be beneficial. 31 Additional evidence to support concrete guidance on the management of immunosuppression in SOT recipients diagnosed with COVID-19 is needed.…”

Follow‐up of renal transplant recipients after acute COVID‐19—A prospective cohort single‐center study

“…However, their study included only 125 renal transplant recipients and was based generally on case reports or case series. 48 While possibly beneficial during the acute COVID‐19 due to the anti‐inflammatory effect, tacrolimus may be associated with an additional endothelial injury 49 , 50 induced by SARS‐CoV‐2. Further studies are needed to clarify these results.…”

“…A recently published meta‐analysis that included 202 solid organ transplant recipients concluded that receiving tacrolimus could benefit COVID‐19. However, their study included only 125 renal transplant recipients and was based generally on case reports or case series 48 . While possibly beneficial during the acute COVID‐19 due to the anti‐inflammatory effect, tacrolimus may be associated with an additional endothelial injury 49,50 induced by SARS‐CoV‐2.…”

The Immunology of SARS-CoV-2 Infection and Vaccines in Solid Organ Transplant Recipients

“…A meta-analysis of data on 202 SOT recipients with COVID-19 suggested that maintaining immunosuppression might be safe in moderate and severe COVID-19. Moreover, tacrolimus could be specifically beneficial [ 138 ].…”