SARS-CoV-2 in Solid Organ Transplant Recipients: A Structured Review of 2020

Abstract

Background : The SARS-CoV-2 pandemic is challenging health systems all over the world. Particularly high-risk groups show considerable mortality rates after infection. In 2020, an inexorable number of case reports, case series and ultimately various systematic reviews have been published reporting on morbidity and mortality risk of SARS-CoV-2 in solid organ transplant (SOT) recipients. However, this vast array of publications resulted in an increasing complexity of the field, overwhelming even the expert reader. Methods : We performed a structured literature review comprising electronic databases, transplant journals and included literature from previous systematic reviews covering the entire year 2020. From 164 included articles we identified 3451 cases of SARS-CoV-2 infected SOT recipients. Results : Infections resulted in a hospitalization rate of 84% and 24% intensive care unit admissions (ICU) in the included patients. Whereas 53.6% of patients were reported to have recovered, cross-sectional overall mortality reported after COVID-19 was at 21.1%. Synoptic data concerning immunosuppressive medication attested to the reduction or withdrawal of antimetabolites (81.9%) and calcineurin inhibitors (48.9%) as a frequent adjustment. In contrast, steroids were reported to be increased in 46.8% of SOT patients. Conclusions : COVID-19 in SOT recipients is associated with high morbidity and mortality worldwide. Conforming with current guidelines, modifications of immunosuppressive therapies mostly comprised a reduction or withdrawal of antimetabolites and calcineurin inhibitors, while frequently maintaining or even increasing steroids. Here, we provide an accessible overview to the topic and synoptic estimates of expectable outcomes regarding in-hospital mortality of SOT patients diseased with COVID-19.

Impact of solid organ transplant status on outcomes of hospitalized patients with COVID‐19 infection

“…The US Centers for Disease Control and Prevention (CDC) recognizes immunosuppression as associated with an increased risk of severe COVID‐19 illness 7 . Previous case series demonstrated increased rates of hospitalization, as well as significant morbidity and mortality in both SOT and stem cell transplant recipients with rates ranging from 13% to 30% 8–11 . Initial case series demonstrated the highest mortality rates at 30%, significantly higher than that reported for nontransplant recipients during similar time periods 12,13 .…”

Outcomes of SARS-CoV-2 infection in patients under treatment with pharmacological immunosuppression. A Swiss cohort study.

“…Confirmation that immunosuppressed patients are more likely to develop a severe disease is relevant to their management and suggests a need for early COVID-19 vaccination in these patient categories [31]. In addition, individualised IS adjustments and prioritisation of COVID-19 treatments for infected subjects on IS, such as monoclonal antibody therapy [45,46], are required. Indeed, immunosuppressed patients with COVID-19 reported longer hospital stays and higher mortality than non-immunosuppressed patients.…”

Solid organ transplantations and COVID-19 disease

“…SOT cases with COVID-19 had a tendency to greater mortality compared with non-SOT controls, although it was not always found to be statistically significant[ 20 , 22 ]. Immunosuppression and comorbidities might put SOT patients at a higher risk from COVID-19, as proposed by new case series[ 23 ].…”