Clinical Characteristics and Outcome of Coronavirus Disease 2019 Infection in Patients with Solid Organ Transplants: A Systematic Review and Meta-Analysis

Abstract

Importance: Although many studies have reported cases of COVID-19 infection in transplant recipients, most of them only involve a small number of patients and narrow geographic areas.Objective: This study aims to investigate the clinical characteristics, morbidity, severity, and mortality of COVID-19 infection among solid organ transplant (SOT) recipients by meta-analysis.Data Sources: We performed a literature search using the databases PubMed, Web of Science, and Google Scholar as of November 26, 2020.Study Selection Pooled incidence proportion (i.e., cumulative incidence) and 95% confidence intervals (CI) were determined to estimate morbidity, severity, and mortality of COVID-19 in SOT recipients as well as clinical symptoms.Data Extraction and Synthesis: Cochrane chi-square test statistic, Q statistic, and Higgin’s I2 statistic were used to evaluate heterogeneity among the studies. Publication bias and sensitivity of the included studies were also tested.Results: Forty-eight studies were included in the meta-analysis. The morbidity rate of COVID-19 in SOT recipients was 2·10% (95% confidence intervals [CI] 1·35-3·01), incidence of severe infection was 22·46% (95% CI 15·74-29·90), and mortality rate was 17·38% (95% CI, 13·72-21·34). In the transplanted organ analysis, the proportion of patients with severe infection was highest in the recipients of two or more transplants (48·85% [95% CI 11·88-86·38]). Further, the mortality rate was highest in lung transplant recipients (25·12% [95% CI 16·94-34·00]). The most common symptoms of COVID-19 in SOT recipients were fever, cough, and respiratory symptoms, which were reported in 73·39%, 58·90%, and 45·77% of patients, respectively. Conclusion and relevance: The SOT was a significant risk factor for worse COVID-19 outcomes, although the morbidity of COVID-19 in SOT recipients was not markedly higher than that in the general population.Funding Statement: The authors received no financial support for the research, authorship, and/or publication of this article.Declaration of Interests: The authors have no conflicts of interest to declare.