key: cord-0702009-bmo2pd7j
authors: Yin, Saifu; Wang, Xianding; Song, Turun
title: Tacrolimus use and COVID-19 infection in patients after solid organ transplantation
date: 2021-02-01
journal: Gastroenterology
DOI: 10.1053/j.gastro.2021.01.223
sha: 32e99570e5830c74cc3cb98a9f922cc4f9fad505
doc_id: 702009
cord_uid: bmo2pd7j

nan

We read with great interest the study by Belli et al. in which the authors have retrospectively analyzed the effect of co-morbidities, immunosuppression and ageing on overall mortality in liver transplant patients with Coronavirus disease .

In this multicenter cohort study, multivariable Cox regression analysis showed that tacrolimus use had a positive effect on patient survival (HR: 0.55; 95%CI: 0.31-0.99) (1) . However, this association was not that solid due to defects in the study design. In this study, 39 patients (16%) received homecare and 204 (84%) needed hospitalization. However, patients receiving homecare had a survival rate of 100% and 82.05% received tacrolimus, while those patients in hospital only had a survival rate of 76.0% and 63.7% received tacrolimus. Additionally, for inpatients, 7.8% stopped CNI and 17.6% reduced CNI compared with 0% stopping CNI and 5.13% reducing CNI in those outpatients. This means that it was more likely for patients with good prognosis (those receiving homecare) to use tacrolimus while those needing hospitalized or ICU admission with worse prognosis tended to stop tacrolimus after diagnosis of COVID-19. Hence, preexisting selection bias in the study contributed to the favorable association between tacrolimus use and better prognosis. Although multivariate COX analyses were conducted, disease severity was not adjusted. It may be more reasonable to do patient stratification or enroll in-hospital patients alone to explore the impact of tacrolimus on prognosis.

In addition, in Colmenero Giving the disputes on the immunosuppression in solid organ transplant (SOT) patients with COVID-19, we have registered a systematic review and meta-analysis in PROSPERO aimed to explore the risk factors of mortality in SOT patients (CRD42020215987). PubMed, Embase, and Cochrane library were searched, and the last search was conducted on December 15, 2020. The disease severity defined in the original study was adopted in this meta-analysis. The quality of observational studies was assessed by using the Newcastle-Ottawa Scale (NOS) (5) . Meta-analysis was performed using R statistical software (version 4.0.0), with the package "meta".

Random-effects analysis was used for all meta-analyses, due to the clinical heterogeneity inherent in the data and the different sample sizes of included studies.

The ORs and 95%CIs were pooled by the inverse variance method (5).

Finally, 11 cohort studies were included (1-4, 6-12). Among them, 7 studies involving In conclusion, our study found that tacrolimus use is not a risk factor for mortality and J o u r n a l P r e -p r o o f severity in SOT patients with COVID-19. Well-designed prospective study is encouraged to verify these findings in the future. 

S- Table 1 : Baseline characteristics of included studies (the other 10 studies).

S- Table 2 : Quality assessment of included studies (the other 10 studies). 

Protective role of tacrolimus, deleterious role of age and comorbidities in liver

Epidemiological pattern, incidence, and outcomes of COVID-19 in liver transplant patients

Respiratory and Gastrointestinal COVID-19 Phenotypes in Kidney Transplant Recipients

Kidney transplant patients with SARS-CoV-2 infection: The Brescia Renal COVID task force experience

Letter to the editor: Famotidine and mortality in COVID-19