BACKGROUND: We aimed to analyze the humoral and cellular response to standard and booster (additional doses) COVID-19 vaccination in solid organ transplantation (SOT) and the risk factors involved for an impaired response. METHODS: We did a systematic review and meta-analysis of studies published up until January 11, 2022, that reported immunogenicity of COVID-19 vaccine among SOT. The study is registered with PROSPERO, number CRD42022300547 RESULTS: : Of the 1527 studies, 112 studies which involved 15391 SOT and 2844 healthy controls were included. SOT showed a low humoral response [effect size (ES): 0.44(0.40-0.48)] in overall and in control studies [log-Odds-ratio (OR): -4.46 (-8.10 to -2.35)]. The humoral response was highest in liver [ES: 0.67(0.61-0.74)] followed by heart [ES: 0.45(0.32-0.59)], kidney [ES: 0.40(0.36-0.45)], kidney-pancreas [ES: 0.33(0.13 - 0.53)], and lung [0.27(0.17-0.37)]. The meta-analysis for standard and booster dose [ES: 0.43(0.39-0.47) versus 0.51(0.43-0.54)] showed a marginal increase of 18% efficacy. SOT with prior infection had higher response [ES: 0.94(0.92- 0.96) vs ES: 0.40(0.39-0.41); p-value < 0.01). The seroresponse with mRNA-12723 mRNA was highest 0.52(0.40-0.64). Mycophenolic acid [OR: 1.42 (1.21 to 1.63)] and Belatacept [OR: 1.89 (1.3 to 2.49)] had highest risk for non-response. SOT had a parallelly decreased cellular response [ES: 0.42(0.32-0.52)] in overall and control studies [OR: -3.12(-0.4.12 to -2.13)] INTERPRETATION: Overall, SOT develops a suboptimal response compared to the general population. Immunosuppression including mycophenolic acid, belatacept, and tacrolimus is associated with decreased response. Booster doses increase the immune response, but further up-gradation in vaccination strategy for SOT is required. This article is protected by copyright. All rights reserved.
- Adults
- Older adults
- Vaccine/vaccination
- COVID-19
- Efficacy/effectiveness
