Coronavirus disease 2019 in liver transplant patients: Clinical and therapeutic aspects

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted liver transplant (LT) activity across the world, with notable decreases in the number of donations and procedures in most Western countries, in particular throughout the first wave. The cumulative incidence of COVID-19 in LT recipients (with estimates ranging from 0.34% to 1.56%) appears to be at least comparable to that observed for the general population. Clinical and radiological features at presentation are also similar to non-transplant patients. The risk of death among LT recipients requiring hospital admission is high (from 12% to 19%), although some authors have suggested that overall mortality may be actually lower compared to the general non-transplant population. It is likely that these poor outcomes may be mainly influenced by the older age and higher comorbidity burden of LT recipients, rather than by the transplant status itself. In fact, it has been hypothesized that post-transplant immunosuppression would exert a protective role, with special focus on tacrolimus-containing regimens. There is scarce evidence to guide the optimal management of post-transplant COVID-19 and the use of antiviral or immunomodulatory therapies, although both clinical practice and guidelines support the dose reduction or withdrawal of anti-proliferative agents such as mofetil mycophenolate. Preliminary reports suggest that the antibody response to messenger RNA vaccines is significantly impaired as compared to non-immunocompromised individuals, in line with other transplant populations. Finally, it is foreseeable that the future will be conditioned by the emerging variants of severe acute respiratory syndrome coronavirus 2 with increased transmissibility among LT recipients.

Gender Differences in COVID-19 Among Liver Transplant Recipients - Results from a Multicenter Brazilian Cohort

“…Within this context, the impact of SARS-CoV-2 infection on these patients is a matter of great concern, especially due to their perceived higher vulnerability resulting from immunosuppression and comorbidities. [1][2][3][4][5] The existing literature presents conflicting findings regarding the effects of COVID-19 on SOT recipients, particularly in the case of liver transplant (LT) recipients. Some authors have noted an increased risk of mortality associated with older age and greater comorbidity burden among these patients, [6][7][8][9][10][11][12][13] while other reports, including meta-analyses, have not reached similar conclusions.…”

Diferenças de Gênero na COVID-19 entre Receptores de Transplante de Fígado: Resultados de uma Coorte Multicêntrica Brasileira

“…2 Teste de soma de classificação de Wilcoxon; teste exato de Fisher; teste qui-quadrado de Pearson. Fonte: Autores.…”