COVID-19 in solid organ transplant recipients: A systematic review and meta-analysis of current literature

Transplant Rev (Orlando). 2021 Jan;35(1):100588. doi: 10.1016/j.trre.2020.100588. Epub 2020 Nov 14.


Severe acute respiratory virus syndrome 2 (SARS-CoV-2) has led to a worldwide pandemic. Early studies in solid organ transplant (SOT) recipients suggested a wide variety of presentations, however, there remains a paucity of robust data in this population. We conducted a systematic review and meta-analysis of SOT recipients with SARS-CoV-2 infection from January 1st t October 9th, 2020. Pooled incidence of symptoms, treatments and outcomes were assessed. Two hundred and fifteen studies were included for systematic review and 60 for meta-analysis. We identified 2,772 unique SOT recipients including 1,500 kidney, 505 liver, 141 heart and 97 lung. Most common presenting symptoms were fever and cough in 70.2% and 63.8% respectively. Majority (81%) required hospital admission. Immunosuppressive medications, especially antimetabolites, were decreased in 76.2%. Hydroxychloroquine and interleukin six antagonists were administered in59.5% and 14.9% respectively, while only few patients received remdesivir and convalescent plasma. Intensive care unit admission was 29% from amongst hospitalized patients. Only few studies reported secondary infections. Overall mortality was 18.6%. Our analysis shows a high incidence of hospital admission in SOT recipients with SARS-CoV-2 infection. As management of SARS-CoV-2 continues to evolve, long-term outcomes among SOT recipients should be assessed in future studies.

Keywords: COVID-19; Immunosuppression; Meta-analysis; SARS-CoV-2; Solid organ transplant; Systematic review.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • COVID-19 / immunology*
  • Humans
  • Immunocompromised Host*
  • Immunosuppression Therapy
  • Pandemics
  • SARS-CoV-2
  • Transplant Recipients*