Clinical Practice Recommendations on the Effect of COVID‐19 Vaccination Strategies on Outcomes in Solid Organ Transplant Recipients
Bibliographic record
Abstract
INTRODUCTION: Solid organ transplant (SOT) recipients were excluded from clinical trials evaluating the efficacy of COVID-19 vaccines. There is uncertainty about the number of doses required to prevent life-threatening infection, as well as uncertainty in the optimal vaccine type and their durability. Our objectives were to provide recommendations on the number of COVID-19 vaccination doses, type of vaccine, dose of vaccine administered, and timing of vaccination in SOT recipients. METHODS: We commissioned a systematic review on COVID-19 vaccination in SOT, focusing on patient-important outcomes. We recruited an international, multidisciplinary panel of 18 stakeholders, including patient partners to summarize our findings using the GRADE (grading of recommendation, assessment, development, and evaluation) framework, rate certainty in the evidence, and develop recommendations. RESULTS: Our panel recommends the routine provision of additional COVID-19 doses after the primary series to SOT recipients with variant-appropriate vaccines (strong recommendation, low certainty evidence). We suggest using any available WHO-approved vaccine rather than selectively choosing a specific type and receiving a single dose rather than a double dose of any COVID-19 vaccine booster (weak recommendation, low certainty evidence). Lastly, we suggest vaccination before transplantation when possible (weak recommendation, low certainty evidence). CONCLUSION: The evidence used to guide these recommendations is limited by the paucity of robust randomized trials evaluating COVID-19 vaccination strategies and clinical outcomes in the SOT population. The provision of higher-quality evidence of the overall effects of COVID-19 vaccination in SOT to inform clinical practice will require large, randomized trials.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.073 | 0.402 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.007 | 0.015 |
| Bibliometrics | 0.009 | 0.006 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.007 | 0.008 |
| Open science | 0.009 | 0.005 |
| Research integrity | 0.014 | 0.011 |
| Insufficient payload (model declined to judge) | 0.017 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".