Abstract
Background
The COVID-19 pandemic has a great impact on solid organ transplant (SOT) recipients due to their comorbidities and their maintenance immunosuppression. So far, studies about the different aspects of the impact of the pandemic on SOT recipients are limited.
Objectives
This systematic review summarizes the risk factors that make SOT patients more vulnerable for severe COVID-19 disease or mortality and the impact of immunosuppressive therapy. Furthermore, their clinical outcomes, mortality risk, immunosuppression, immunity and COVID-19 vaccination efficacy are discussed.
Methods
A systematic search on PubMed was performed to select original articles on SOT recipients concerning the following four topics: (1) mortality and clinical course; (2) risk factors for mortality and composite outcomes; (3) maintenance immunosuppression; (4) immunity to COVID-19 infection and (5) vaccine immunogenicity. Relevant data were extracted, analyzed and summarized in tables.
Results
This systematic review includes 77 articles. Mortality was associated with advanced age. Post-transplantation time or comorbidities were variably identified as independent risk factors for mortality or severe disease. However, generally, no comorbidity was reported as a major risk factor. SOT recipients have a higher risk of acute kidney injury, but no higher rate of mortality compared to non-transplanted patients was found. Immunosuppression was individually adjusted, without leading to high rates of graft dysfunction. Generally, no association between type of immunosuppression and mortality was found. SOT patients established humoral and cellular immune responses after COVID-19 disease comparable to immunocompetent people. At last, SOT patients experience a diminished immune response after two-dose vaccination with SARS-COV-2-mRNA-vaccines.
Conclusion
More research is needed to address the direct effect of COVID-19 disease on the graft in lung transplant recipients, as well as the factors ameliorating the immune response in SOT recipients.
【저자키워드】 COVID-19, vaccination, Risk factors, Mortality, solid organ transplantation, Immunosuppression, 【초록키워드】 Efficacy, immune response, pandemic, therapy, Immunity, Cellular immune response, COVID-19 pandemic, systematic review, Comorbidity, Acute kidney injury, risk factor, clinical outcomes, COVID-19 disease, COVID-19 vaccination, COVID-19 infection, Research, Patient, lung transplant, severe COVID-19 disease, solid organ transplant, association, mortality risk, severe disease, immunosuppressive, vaccine immunogenicity, humoral, SOT, dysfunction, Factor, higher risk, recipients, advanced age, independent risk factor, article, recipient, objective, articles, Result, analyzed, include, reported, was performed, adjusted, comparable, concerning, SOT patient, 【제목키워드】 finding, organ,