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Comparison of COVID-19 outcomes in organ transplant recipients (OTr) and non-transplant patients: a study protocol for rapid review.
Syst Rev. 2021 11 21; 10(1):299.SR

Abstract

BACKGROUND

The COVID-19 pandemic has devastated the global community with nearly 4.9 million deaths as of October 2021. While organ transplant (OT) recipients (OTr) may be at increased risk for severe COVID-19 due to their chronic immunocompromised state, outcomes for OTr with COVID-19 remain disputed in the literature. This review will examine whether OTr with COVID-19 are at higher risk for severe illness and death than non-immunocompromised individuals.

METHODS

MEDLINE (via Ovid and PubMed) and EMBASE (via Embase.com) will be searched from December 2019 to October 2021 for observational studies (including cohort and case-control) that compare COVID-19 clinical outcomes in OTr to those in individuals without history of OT. The primary outcome of interest will be mortality as defined in each study, with possible further analyses of in-hospital mortality, 28 or 30-day mortality, and all-cause mortality versus mortality attributable to COVID-19. The secondary outcome of interest will be the severity of COVID-19 disease, most frequently defined as requiring intensive care unit admission or mechanical ventilation. Two reviewers will independently screen all abstracts and full-text articles. Potential conflicts will be resolved by a third reviewer and potentially discussion among all investigators. Methodological quality will be appraised using the Newcastle-Ottawa Scale. If data permit, we will perform random-effects meta-analysis with the Sidik-Jonkman estimator and the Hartung-Knapp adjustment for confidence intervals to estimate a summary measure of association between histories of transplant with each outcome. Potential sources of heterogeneity will be explored using meta-regression. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., subgroup analysis) considering least minimal adjustment for confounders.

DISCUSSION

This rapid review will assess the available evidence on whether OTr diagnosed with COVID-19 are at higher risk for severe illness and death compared to non-immunocompromised individuals. Such knowledge is clinically relevant and may impact risk stratification, allocation of organs and healthcare resources, and organ transplantation protocols during this, and future, pandemics.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework (OSF) registration DOI: https://doi.org/10.17605/osf.io/4n9d7 .

Authors+Show Affiliations

The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02906, USA.The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02906, USA.Department of Medicine, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA.Brown University School of Public Health, 121 South Main Street, RI, 02906, Providence, USA.Brown University Library, 10 Prospect Street, RI, 02912, Providence, USA.Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Gerry House 111, Providence, RI, 02903, USA. dimitrios_farmakiotis@brown.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

34802460

Citation

Lerner, Alexis H., et al. "Comparison of COVID-19 Outcomes in Organ Transplant Recipients (OTr) and Non-transplant Patients: a Study Protocol for Rapid Review." Systematic Reviews, vol. 10, no. 1, 2021, p. 299.
Lerner AH, Klein EJ, Hardesty A, et al. Comparison of COVID-19 outcomes in organ transplant recipients (OTr) and non-transplant patients: a study protocol for rapid review. Syst Rev. 2021;10(1):299.
Lerner, A. H., Klein, E. J., Hardesty, A., Panagiotou, O. A., Misquith, C., & Farmakiotis, D. (2021). Comparison of COVID-19 outcomes in organ transplant recipients (OTr) and non-transplant patients: a study protocol for rapid review. Systematic Reviews, 10(1), 299. https://doi.org/10.1186/s13643-021-01854-8
Lerner AH, et al. Comparison of COVID-19 Outcomes in Organ Transplant Recipients (OTr) and Non-transplant Patients: a Study Protocol for Rapid Review. Syst Rev. 2021 11 21;10(1):299. PubMed PMID: 34802460.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of COVID-19 outcomes in organ transplant recipients (OTr) and non-transplant patients: a study protocol for rapid review. AU - Lerner,Alexis H, AU - Klein,Elizabeth J, AU - Hardesty,Anna, AU - Panagiotou,Orestis A, AU - Misquith,Chelsea, AU - Farmakiotis,Dimitrios, Y1 - 2021/11/21/ PY - 2021/06/12/received PY - 2021/11/04/accepted PY - 2021/11/22/entrez PY - 2021/11/23/pubmed PY - 2021/11/26/medline KW - COVID-19 KW - Immunosuppression KW - Organ transplant SP - 299 EP - 299 JF - Systematic reviews JO - Syst Rev VL - 10 IS - 1 N2 - BACKGROUND: The COVID-19 pandemic has devastated the global community with nearly 4.9 million deaths as of October 2021. While organ transplant (OT) recipients (OTr) may be at increased risk for severe COVID-19 due to their chronic immunocompromised state, outcomes for OTr with COVID-19 remain disputed in the literature. This review will examine whether OTr with COVID-19 are at higher risk for severe illness and death than non-immunocompromised individuals. METHODS: MEDLINE (via Ovid and PubMed) and EMBASE (via Embase.com) will be searched from December 2019 to October 2021 for observational studies (including cohort and case-control) that compare COVID-19 clinical outcomes in OTr to those in individuals without history of OT. The primary outcome of interest will be mortality as defined in each study, with possible further analyses of in-hospital mortality, 28 or 30-day mortality, and all-cause mortality versus mortality attributable to COVID-19. The secondary outcome of interest will be the severity of COVID-19 disease, most frequently defined as requiring intensive care unit admission or mechanical ventilation. Two reviewers will independently screen all abstracts and full-text articles. Potential conflicts will be resolved by a third reviewer and potentially discussion among all investigators. Methodological quality will be appraised using the Newcastle-Ottawa Scale. If data permit, we will perform random-effects meta-analysis with the Sidik-Jonkman estimator and the Hartung-Knapp adjustment for confidence intervals to estimate a summary measure of association between histories of transplant with each outcome. Potential sources of heterogeneity will be explored using meta-regression. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., subgroup analysis) considering least minimal adjustment for confounders. DISCUSSION: This rapid review will assess the available evidence on whether OTr diagnosed with COVID-19 are at higher risk for severe illness and death compared to non-immunocompromised individuals. Such knowledge is clinically relevant and may impact risk stratification, allocation of organs and healthcare resources, and organ transplantation protocols during this, and future, pandemics. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework (OSF) registration DOI: https://doi.org/10.17605/osf.io/4n9d7 . SN - 2046-4053 UR - https://www.unboundmedicine.com/medline/citation/34802460/Comparison_of_COVID_19_outcomes_in_organ_transplant_recipients__OTr__and_non_transplant_patients:_a_study_protocol_for_rapid_review_ L2 - https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-021-01854-8 DB - PRIME DP - Unbound Medicine ER -