Abstract
BackgroundThe COVID-19 pandemic has devastated the global community with nearly 4.9 million deaths as of October 2021. While organ transplant (OT) recipients (OTr) may be at increased risk for severe COVID-19 due to their chronic immunocompromised state, outcomes for OTr with COVID-19 remain disputed in the literature. This review will examine whether OTr with COVID-19 are at higher risk for severe illness and death than non-immunocompromised individuals.MethodsMEDLINE (via Ovid and PubMed) and EMBASE (via Embase.com) will be searched from December 2019 to October 2021 for observational studies (including cohort and case-control) that compare COVID-19 clinical outcomes in OTr to those in individuals without history of OT. The primary outcome of interest will be mortality as defined in each study, with possible further analyses of in-hospital mortality, 28 or 30-day mortality, and all-cause mortality versus mortality attributable to COVID-19. The secondary outcome of interest will be the severity of COVID-19 disease, most frequently defined as requiring intensive care unit admission or mechanical ventilation. Two reviewers will independently screen all abstracts and full-text articles. Potential conflicts will be resolved by a third reviewer and potentially discussion among all investigators. Methodological quality will be appraised using the Newcastle-Ottawa Scale. If data permit, we will perform random-effects meta-analysis with the Sidik-Jonkman estimator and the Hartung-Knapp adjustment for confidence intervals to estimate a summary measure of association between histories of transplant with each outcome. Potential sources of heterogeneity will be explored using meta-regression. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., subgroup analysis) considering least minimal adjustment for confounders.DiscussionThis rapid review will assess the available evidence on whether OTr diagnosed with COVID-19 are at higher risk for severe illness and death compared to non-immunocompromised individuals. Such knowledge is clinically relevant and may impact risk stratification, allocation of organs and healthcare resources, and organ transplantation protocols during this, and future, pandemics.Systematic review registrationOpen Science Framework (OSF) registration DOI: https://doi.org/10.17605/osf.io/4n9d7.
Highlights
The COVID-19 pandemic has devastated the global community with nearly 4.9 million deaths as of October 2021
Other reports have found no significant differences in length of stay (LOS) or clinical outcomes between Organ transplant recipients (OTr) and non-transplant patients with COVID-19, and question whether chronic immunosuppression impacts COVID-19 outcomes in OTr
Emerging data suggest mortality may be lower in OTr who are maintained on their chronic immunosuppressive therapy throughout the course of COVID-19 illness
Summary
Design This rapid review will compare clinical outcomes of COVID-19 between OTr and patients without a history of transplant (controls). Data synthesis We will perform narrative synthesis using evidence tables and evidence maps to describe the PICOTS elements, including study characteristics (e.g., author, journal, study design), population characteristics (e.g., eligibility, type of transplant, age distribution, demographics, definitions of COVID positivity), outcome operationalization (e.g., definitions of mortality, measures of effect estimates), covariates for which statistical models are adjusted, and findings. We will assess the presence of small-study effects visually with funnel plots and statistically using Egger’s regression; both methods provide evidence for whether smaller vs larger studies give systematically different results, which may be due to publication bias as well as other meta-biases [13] Both adjusted and unadjusted estimates of association will be extracted, we will synthesize separately those for which primary studies have performed some adjustment for confounders, e.g., through regression, matching, or other approach. Software considerations All analyses will be conducted in Stata version 17 (StataCorp LP, College Station, TX, USA) and R (R Foundation, Vienna, Austria)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
