COVID-19 in 823 Transplant patients: A Systematic Scoping Review

  1. Moataz Maher Emara
  2. Mahmoud Elsedeiq
  3. Mohamed Elmorshedi
  4. Hamed Neamatallah
  5. Mostafa Abdelkhalek
  6. Amr Yassen
  7. Ashraf Nabhan

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Abstract

Background

Management of COVID-19 in transplant patients is a big challenge. Data on immunosuppression management, clinical picture, and outcomes are lacking.

Objectives

To summarize the current literature on COVID-19 in transplant patients especially the data regarding the immunosuppression protocols, clinical presentation, and outcomes.

Search strategy

A systematic search of MEDLINE, EBSCO, CENTRAL, CINAHL, LitCovid, Web of Science, and Scopus electronic databases. The references of the relevant studies were also searched. The search was last updated on June 3, 2020.

Selection Criteria

Primary reports of solid organ transplant patients who developed COVID-19. An overlap of cases in different reports was checked.

Data collection and analysis

A descriptive summary of immunosuppression therapy (before and after COVID-19), clinical presentation (symptoms, imaging, laboratory, and disease severity), management (oxygen therapy, antiviral, and antibacterial), major outcomes (Intensive care admission, invasive mechanical ventilation, acute kidney injury), and mortality.

Main results

We identified 74 studies reporting 823 cases of solid organ transplantation with COVID-19. Among 372 patients, 114 (30.6%) were mild COVID-19, 101 (27.2%) moderate, and 157 (42.2%) severe or critical.

Major outcomes included intensive care unit admission, invasive ventilation, and acute kidney injury, which occurred in 121 (14.7%), 97 (11.8%), and 63 (7.7%) of patients, respectively. Mortality was reported in 160 (19.4%) patients. Missing individual data hindered making clinical correlations.

Conclusion

COVID-19 in solid organ transplant patients probably has a more disease severity, worse major outcomes (Intensive care admission, invasive ventilation, acute kidney injury), and higher mortality than in non-transplant patients.

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  1. ScreenIT

    SciScore for 10.1101/2021.01.18.21250025: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    II- Identifying relevant studies: A systematic search in MEDLINE, EBSCO, CENTRAL, CINAHL,
    MEDLINE
    suggested: (MEDLINE, RRID:SCR_002185)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    We had some limitations in our scoping review. This report only included case-reports, case series, and one case-control study; however, this was the best available data. Missed individual data and the aggregate data from the case series hindered us from extracting proper associations between case severity, immunosuppression protocol, and major outcomes. Our reporting was only up to the date of June 3, 2020. We did not include a critical appraisal of the primary reports. Patient duplication should be minimal as we traced cases carefully and contacted authors for primary source overlap. In conclusion, our results suggest that COVID-19 in transplant patients has a more severe course, worse major outcomes (ICU admission, Invasive MV, AKI), and higher mortality than non-transplant patients.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.01.18.21250025v1 on medRxiv