Survival and clinical outcomes of kidney transplant recipients with coronavirus disease infection: An updated systematic review and meta-analysis

The recent outbreak of the 2019 novel coronavirus disease (COVID-19) has raised a tremendous global concern among people, especially those with pre-existing comorbidities. Kidney transplant (KT) recipients represent a susceptible category of patients due to the long-term administration of immunosuppressive therapy. However, data on how COVID-19 is affecting these patients are scarce. We aim to systematically review the current findings regarding survival and clinical outcomes of KT recipients with COVID-19 infection. A comprehensive literature search was conducted from PubMed and Embase published up to May 2021. Studies reporting data on the incidence of COVID-19 infection among KT recipients were included. The primary outcomes analyzed in this study, including mortality rate, mechanical ventilation requirement, intensive care unit (ICU) admission, and acute kidney injury (AKI) occurrence, were measured as a pooled prevalence rate (PR) with 95% confidence intervals (CIs). All analyses were performed using STATA(®) 16. A total of 30 studies comprising 3,146 KT recipients with COVID-19 infections were included. The pooled PR of mortality among KT recipients with COVID-19 infection was 21% (95% CI, 18% to 25%), ICU admission, 24% (95% CI, 20% to 28%), mechanical ventilation, 18% (95% CI, 15% to 21%), and AKI, 48% (95% CI, 42% to 53%). Meta-regression analysis showed that age was significantly associated with a higher mortality rate (P < .01). Mortality rate associated with age and relatively poor clinical outcomes were high among KT recipients with COVID-19 infection. Further studies addressing preventive measures for this at-risk population should be encouraged.