Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatangar, Bareilly 243122, Uttar Pradesh, India
Shin Jie Yong
Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Subang Jaya 47500, Malaysia
Firzan Nainu
Department of Pharmacy, Faculty of Pharmacy, Hasanuddin University, Makassar 90245, Indonesia
Khalid Hajissa
Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
Nourah Al Dossary
General Surgery Department, Alomran General Hospital, Ministry of Health, Al-Ahsa 36358, Saudi Arabia
Khulood Khaled Alajmi
Pharmacy Department, Al-Ahsa Mental Health Hospital, Al-Ahsa 31982, Saudi Arabia
Afaf E. Al Saggar
Administration of Accreditation, Quality and Performance Excellence Management, Riyadh 3rd Health Cluster, Ministry of Health, Riyadh 13717, Saudi Arabia
Fahad Abdullah AlHarbi
Clinical Pharmacy Services—Nephrology Department, King Saud Hospital, Ministry of Health, Riyadh 56437, Saudi Arabia
Mohammed Buhays Aswany
Administration of Supply and Shared Services, C1 Riyadh Health Cluster, Ministry of Health, Riyadh 11622, Saudi Arabia
Abdullah Abdulaziz Alshayee
Administration of Supply and Shared Services, C1 Riyadh Health Cluster, Ministry of Health, Riyadh 11622, Saudi Arabia
Saad Abdalaziz Alrabiah
Administration of Supply and Shared Services, C1 Riyadh Health Cluster, Ministry of Health, Riyadh 11622, Saudi Arabia
Ahmed Mahmoud Saleh
Administration of Supply and Shared Services, C1 Riyadh Health Cluster, Ministry of Health, Riyadh 11622, Saudi Arabia
Mohammed Ali Alqarni
Administration of Supply and Shared Services, C1 Riyadh Health Cluster, Ministry of Health, Riyadh 11622, Saudi Arabia
Fahad Mohammed Al Gharib
Administration of Compliance, Directorate of Health Affairs, Ministry of Health, Eastern Region, Al-Ahsa 36441, Saudi Arabia
Shahd Nabeel Qattan
Diagnostic Radiology Department, Prince Sultan Military Medical City, Riyadh 12233, Saudi Arabia
Hassan M. Almusabeh
Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi Arabia
Hussain Yousef AlGhatm
Clinical Pharmacy Department, Gurayat General Hospital, Ministry of Health, Gurayat 77471, Saudi Arabia
Sameer Ahmed Almoraihel
Pharmacy Department, Aljafr General Hospital, Ministry of Health, Al-Ahsa 77110, Saudi Arabia
Ahmed Saeed Alzuwaid
Pharmacy Department, Aljafr General Hospital, Ministry of Health, Al-Ahsa 77110, Saudi Arabia
Mohammed Ali Albaqshi
Pharmacy Department, Aljafr General Hospital, Ministry of Health, Al-Ahsa 77110, Saudi Arabia
Murtadha Ahmed Al Khalaf
Pharmacy Department, Aljafr General Hospital, Ministry of Health, Al-Ahsa 77110, Saudi Arabia
Yasmine Ahmed Albaqshi
Respiratory Therapy Department, Maternity and Children Hospital, Ministry of Health, Al-Ahsa 36422, Saudi Arabia
Abdulsatar H Al Brahim
Pharmacy Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa 36441, Saudi Arabia
Mahdi Mana Al Mutared
Psychological Service Department, Ardha and Mental Health Complex, Ministry of Health, Najran 66248, Saudi Arabia
Hassan Al-Helal
Division of Laboratory, Medical Microbiology Department, Maternity and Children Hospital, Ministry of Health, Al-Ahsa 36422, Saudi Arabia
Header A Alghazal
Microbiology Laboratory, Prince Saud Bin Jalawi Hospital, Ministry of Health, Al-Ahsa 36424, Saudi Arabia
Abbas Al Mutair
Research Center, Almoosa Specialist Hospital, Al-Ahsa 36342, Saudi Arabia
Background: Solid organ rejection post-SARS-CoV-2 vaccination or COVID-19 infection is extremely rare but can occur. T-cell recognition of antigen is the primary and central event that leads to the cascade of events that result in rejection of a transplanted organ. Objectives: To describe the results of a systematic review for solid organ rejections following SARS-CoV-2 vaccination or COVID-19 infection. Methods: For this systematic review and meta-analysis, we searched Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines for studies on the incidence of solid organ rejection post-SARS-CoV-2 vaccination or COVID-19 infection, published from 1 December 2019 to 31 May 2022, with English language restriction. Results: One hundred thirty-six cases from fifty-two articles were included in the qualitative synthesis of this systematic review (56 solid organs rejected post-SARS-CoV-2 vaccination and 40 solid organs rejected following COVID-19 infection). Cornea rejection (44 cases) was the most frequent organ observed post-SARS-CoV-2 vaccination and following COVID-19 infection, followed by kidney rejection (36 cases), liver rejection (12 cases), lung rejection (2 cases), heart rejection (1 case) and pancreas rejection (1 case). The median or mean patient age ranged from 23 to 94 years across the studies. The majority of the patients were male (n = 51, 53.1%) and were of White (Caucasian) (n = 51, 53.7%) and Hispanic (n = 15, 15.8%) ethnicity. A total of fifty-six solid organ rejections were reported post-SARS-CoV-2 vaccination [Pfizer-BioNTech (n = 31), Moderna (n = 14), Oxford Uni-AstraZeneca (n = 10) and Sinovac-CoronaVac (n = 1)]. The median time from SARS-CoV-2 vaccination to organ rejection was 13.5 h (IQR, 3.2–17.2), while the median time from COVID-19 infection to organ rejection was 14 h (IQR, 5–21). Most patients were easily treated without any serious complications, recovered and did not require long-term allograft rejection therapy [graft success (n = 70, 85.4%), graft failure (n = 12, 14.6%), survived (n = 90, 95.7%) and died (n = 4, 4.3%)]. Conclusion: The reported evidence of solid organ rejections post-SARS-CoV-2 vaccination or COIVD-19 infection should not discourage vaccination against this worldwide pandemic. The number of reported cases is relatively small in relation to the hundreds of millions of vaccinations that have occurred, and the protective benefits offered by SARS-CoV-2 vaccination far outweigh the risks.
