RESUMEN
The impact of COVID-19 vaccination on clinical outcomes in solid organ transplant (SOT) recipients remains unclear. This systematic review and network meta-analysis sought to assess the efficacy and safety of COVID-19 vaccination in SOT recipients. We searched 6 databases from inception to March 1, 2024 for randomized controlled trials (RCTs) and observational studies evaluating different COVID-19 vaccination strategies in SOT recipients. Based on patient-important outcomes, we performed frequentist random-effects pairwise meta-analyses and network meta-analyses, separating RCTs and nonrandomized evidence, and used the Grading of Recommendation, Assessment, Development, and Evaluation approach to assess our certainty in the evidence. We included 6 RCTs (N = 814) and 43 observational studies (N = 125 199). Overall, there is a paucity of randomized evidence evaluating COVID-19 vaccines in SOT recipients. The nonrandomized evidence evaluating COVID-19 vaccination strategies patient-important outcomes, including COVID-19 infection, mortality, hospitalization, ICU admission, and rejection, demonstrated low to very low certainty due to the included studies' risk of bias. Throughout the COVID-19 pandemic, clinicians and SOT recipients worked with minimal, very low-quality evidence in relation to COVID-19 vaccines in this population. In the instance of future public health emergencies, clinicians and researchers should collaborate closely with patient partners to ensure there is sufficient evidence in the transplant population on patient-important outcomes.
RESUMEN
AIM: Multisystem inflammatory syndrome in children (MIS-C) is a novel condition that can occur post-SARS-CoV-2 infection in children and adolescents. There is a paucity of evidence on the prognostic factors associated with MIS-C. The aim of this systematic review and meta-analysis was to summarise the prognostic factors for MIS-C development. METHODS: Five databases were systematically searched from January 2020 to May 2023 for studies reporting on prognostic factors for MIS-C using multivariable regression models. Random-effects meta-analyses were conducted to pool odds ratios for each prognostic factor. Risk of bias was rated using QUIPS and the GRADE framework was used to assess the certainty of evidence for each unique factor. RESULTS: Twelve observational studies (N = 18 024) were included, and 13 unique prognostic factors were amenable to meta-analysis. With moderate certainty, age <12 years, male sex and Black race probably increase the risk of MIS-C. Malignancy and underlying respiratory disease probably decrease the risk of MIS-C. Low-certainty evidence suggests that Asian race may increase the risk of MIS-C, and comorbidity may decrease the risk of MIS-C. CONCLUSION: Current literature presents several prognostic factors related to MIS-C following SARS-CoV-2 infection. Further research is necessary to elucidate the pathophysiologic mechanisms related to MIS-C.