Transplant Trial Watch

A systematic review and meta-analysis of COVID-19 in kidney transplant recipients: Lessons to be learned.

Kremer, D., et al.

American Journal of Transplantation 2021 [record in progress].


Aims
The main aim of this study was to evaluate all current evidence in order to provide a comprehensive and up-to-date insight into COVID-19 in kidney transplant patients.

Interventions
A literature search was performed using the World Health Organization (WHO) COVID-19 database. Abstracts and titles of studies were screened by three reviewers, followed by selection of eligible studies by two reviewers and independent extraction of data. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS).

Participants
74 studies were included in the review.

Outcomes
Hospitalization, length of hospitalization, incidence of acute kidney injury (AKI), kidney function after discharge, requirement for dialysis treatment, kidney graft failure or rejection and mortality.

Follow-up
N/A

CET Conclusions
The systematic review aimed to summarise the evidence regarding the clinical course and outcome of COVID-19 in kidney transplant recipients, and treatment modalities and modifications in immunosuppression. The review was registered with PROSPERO. The comprehensive bibliographic search was done up to January 2021 and identified 74 single-arm studies (n=5559) for inclusion that reported on at least five patients. Screening, study selection and data extraction were conducted by independent reviewers. The methodological quality was assessed using the Newcastle-Ottawa scale but it was not described whether this was done by independent reviewers. The overall reported mortality of hospitalised patients with COVID-19 was 23% (95%CI 21% -27%) and reported acute kidney injury (AKI) was 50% (95% CI 44%-56%). No evidence was found for any of the potential risk factors for mortality or AKI, including age, sex, anthropometrics or comorbidities. Dose reductions of immunosuppression were common, particularly of proliferation inhibitors and calcineurin inhibitors although the studies did not provide sufficient details to meta-analyse the data for different subgroups. Sensitivity analyses included only studies reporting on at least 100 patients and reported similar outcomes for the risk of mortality and AKI.

Trial registration
PROSPERO - CRD42021235502

Funding source
Not reported