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.

中文翻译：

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实体器官移植受者接种 COVID-19 疫苗的有效性和安全性：系统评价和网络荟萃分析


COVID-19 疫苗接种对实体器官移植 （SOT） 受者临床结果的影响仍不清楚。本系统评价和网络荟萃分析旨在评估 COVID-19 疫苗接种在 SOT 接受者中的有效性和安全性。我们从建库到 2024 年 3 月 1 日检索了 6 个数据库，以查找随机对照试验 （RCT） 和观察性研究，以评估 SOT 接受者的不同 COVID-19 疫苗接种策略。基于患者重要结局，我们进行了频率随机效应成对meta分析和网状meta分析，将RCT和非随机证据分开，并使用推荐、评估、开发和评价分级方法来评估我们的证据质量。我们纳入了 6 项 RCT （N = 814） 和 43 项观察性研究 （N = 125 199）。总体而言，缺乏评估 SOT 接受者中 COVID-19 疫苗的随机证据。由于纳入研究的偏倚风险，评估 COVID-19 疫苗接种策略患者重要结局（包括 COVID-19 感染、死亡率、住院、ICU 收治和排斥反应）的非随机证据显示出低到极低的质量。在整个 COVID-19 大流行期间，临床医生和 SOT 接受者与该人群的 COVID-19 疫苗相关的证据最少、质量极低。在未来发生公共卫生紧急情况时，临床医生和研究人员应与患者合作伙伴密切合作，以确保移植人群中有足够的证据证明患者重要结局。