Clinical characteristics and outcome of coronavirus disease 2019 infection in patients with solid organ transplants: A systematic review and meta-analysis

Abstract

Background: 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. 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. Method: We performed a literature search using the databases PubMed, Web of Science, and Google Scholar as of November 26, 2020. We included randomized controlled trials and cohort studies, excluding case reports and small case series (n < 10). The pooled incidence proportion and 95% confidence intervals (CI) were used to estimate the combined results of forty-seven studies were included for the meta-analysis. Heterogeneity was assessed using I2. Freeman-Tukey double arcsine transformation was used to stabilize the specific rate variance. Publication bias was using Egger's test. Results: The morbidity rate of COVID-19 in SOT recipients was 2.10% [95% CI 1.35–3.01], and the proportion of severe infection was 22.46% [95% CI 15.74–29.90]. The mortality rate was 17.38% [95% CI 13.72–21.34]. In the analysis by transplanted organ, the proportion of patients with severe infection was highest in recipients of two or more transplants 48.85% [95% CI 11.88–86.38]. 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 (73.39%), cough (58.90%), and respiratory symptoms (45.77%). Conclusion: SOT was a risk factor for worse COVID-19 outcomes, although the morbidity of COVID-19 in SOT recipients was not markedly higher than the general population. These results may change when our understanding of the disease progress.