COVID‐19 clinical manifestations and treatment strategies among solid‐organ recipients: A systematic review of cases

Abstract

Background COVID‐19 has been spreading worldwide with a significant death toll. Solid‐organ transplantation (SOT) recipients are at higher risk due to their suppressed immune system. In this study, we aimed to conduct a systematic review on COVID‐19 clinical manifestations and treatment strategies in SOT recipients. Methods We searched three databases for relevant terms related to COVID‐19 and transplantation. 50 studies, including 337 patients, were reviewed. Results 236 patients were male, with a mean age of 49.9 years. The most prevalent group was the kidney 57.0%, followed by 17.2% heart, and 13.6% liver. Fever and Cough were the most reported clinical presentations. Infiltration (55.4%) in chest x‐ray and ground‐glass opacity (67.1%) in CT scans were the most radiological findings. It was found that 96.8% and 72.4% of patients present with CRP level and lymphocytopenia, respectively, and 70.6% of kidney recipients patients presented with high creatinine levels. The most common baseline immunosuppressants were Calcineurin inhibitors (88.9%), and antimetabolites (73.2%). Antimetabolites (84.3%) and Calcineurin inhibitors (54.3%) were discontinued/decreased 84.3% whereas glucocorticoids dosage almost have no change (77.9%) or even increased. 18.4% of cases had died, and 65.9% were discharged. Conclusions Patients’ demographics, signs, symptoms, and radiographic findings in SOT recipients are almost similar to the general population. However, gastrointestinal symptoms appear to be more common. There are different treatment strategies, but in most of them, antimetabolite and Calcineurin inhibitors were decreased or discontinued, while corticosteroids were increased. Finally, Covid‐19 seems to be more severe and has higher mortality in SOT recipients compared to the general population.

Impact of COVID-19 in solid organ transplant recipients

“…The presentation of SOT recipients with COVID‐19 appears similar to the general population. Fever (61–83%), cough (45–75%), and diarrhea (22–57%) were the most common symptoms reported 14‐16,71,75,79,80,83‐88 . Abnormalities in chest imaging occurred frequently; cohorts of SOT recipients in New York City reported abnormal chest radiographs in 96%–100% 83,84 .…”

“…All‐cause mortality during the study period of the UK registry reached 26% for SOT recipients and 10% for those on the waitlist, although local utilization decisions related to resource availability may have impacted these numbers 74 . The largest cohort to date including 482 SOT recipients from more than 50 transplant centers reported 20.5% mortality, and two compilations of cases found 18%–19% mortality overall 17,87,88 . In a UK database analyzing 10926 COVID‐19 related deaths, SOT recipients had a hazard ratio of 3.53 [95% CI 2.77–4.49] for death as compared to the general population 105 .…”

Effect of Calcineurin Inhibitors and Mammalian Target of Rapamycin Inhibitors on the Course of COVID-19 in Kidney Transplant Recipients

“…A recently published article argued that the use of calcineurin inhibitors would be beneficial in the pandemic course [ 8 ]. Studies have shown that the cytopathic effect of the virus, oxidant system activation, and cytokine storm are cornerstones in the pathogenesis of COVID-19 [ 2 , 3 ]. In the early stages of the COVID-19 pandemic, it was speculated that immunosuppressive therapy would facilitate the cytopathic effects of the virus.…”

“…In a systematic review including 50 studies and 337 patients, Moosavi et al analyzed the drug modification strategies. Generally, anti-metabolite and CNI were reduced or discontinued, and steroid doses were increased, in patients with solid-organ transplantation and COVID-19 [ 3 ], but patient outcomes could not be assessed if they were associated with decreased immunosuppression or increased steroid dose. There are different strategies determined according to the patient’s clinical condition and the approach of the transplantation centers.…”

Manifestaciones clínicas y complicaciones de la enfermedad por coronavirus 2019 (COVID-19): revisión de la literatura

“…riñón, hígado, pulmón) son similares a los de la población general, aunque presentan con mayor frecuencia síntomas gastrointestinales. En estos individuos la COVID-19 parece ser más grave y tiene una mayor mortalidad (18.4%) en comparación con la población general (Moosavi et al, 2020).…”