COVID-19 in liver transplant patients: Impact and considerations

Khazaaleh, Shrouq; Alomari, Mohammad; Sharma, Sonal; Kapila, Nikhil; Zervos, Xaralambos; Gonzalez, Adalberto

doi:10.5500/wjt.v13.i1.1

Cited by 8 publications

(5 citation statements)

References 44 publications

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“…Medical laboratory professionals directing or performing TDM for tacrolimus (or other TDM drugs) should consider the distribution of measured values observed in their patient population and validate a higher clinical reportable range to meet clinical need, if needed. It is well documented that concurrent administration of Paxlovid (containing ritonavir) and tacrolimus can cause drug-drug interaction with delayed clearance of tacrolimus [ [7] , [8] , [9] , [10] , [11] , [12] , [13] ], though continuous education of healthcare team members is encouraged in order to mitigate concurrent therapies and risk of potential adverse side effects.…”

Section: Conclusion/discussionmentioning

confidence: 99%

“…Metabolism of tacrolimus occurs extensively in the liver by cytochrome P450 enzymes (CYP3A4 and CYP3A5) and by P-glycoprotein (PGP) [ 3 , 5 , 6 ]. A drug-drug interaction of Paxlovid (combination of nirmatrelvir/ritonavir) for treatment of SARS-CoV-2 infection (COVID-19) has been widely reported in the literature as ritonavir is known to inhibit CYP3A4 and, to a lesser extent, PGP, which directly impacts tacrolimus metabolism [ [7] , [8] , [9] , [10] , [11] , [12] ]. Co-administration of ritonavir with tacrolimus has been shown to lead to delayed clearance and potential toxic concentrations of tacrolimus in the blood [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Monitoring tacrolimus toxicity following Paxlovid administration in a liver transplant patient

Maynard

Bates

Korpi-Steiner

2023

Practical Laboratory Medicine

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Section: Conclusion/discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Monitoring tacrolimus toxicity following Paxlovid administration in a liver transplant patient

Maynard

Bates

Korpi-Steiner

2023

Practical Laboratory Medicine

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“…However, there is limited information about the course of COVID-19 disease in liver transplant patients. 9 In our study, we evaluated the patients who needed hospitalization among COVID-19 positive patients with liver transplant who referred to our hospital, which is the reference pandemic hospital of the region and found 14.3% mortality and 25% ICU rates.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of liver transplantation patients infected with COVID-19: pandemic hospital experience from Turkey

AKYOL,

DÜZENLİ

2023

Journal of Health Sciences and Medicine

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Aims: There are conflicting results for the course of the disease and mortality rates for liver transplantation patients infected with COVID-19. In this study, we aimed to present the outcomes of our liver transplant patients who were hospitalized and followed up in our tertiary hospital, which served as a pandemic hospital for COVID-19. Methods: Patients hospitalized with the diagnosis of COVID-19 between March 1, 2020 and March 1, 2022 in Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital and Prof. Dr. Feriha Öz Pandemic Hospital were included. In this retrospective observational study, the clinical data of the patients, the need for intensive care hospitalization, and mortality rates were recorded by hospital computer system. The relationships were analyzed with SPSS v20.0. Results: There were 25996 patients who were hospitalized with the diagnosis of COVID-19 and 28 of them were with the history of liver transplantation. Ages of the liver transplant patients ranged from 18 to 73, with a median age of 52. 82.1% of the patients were male and 17.9% were female. Intensive care unit hospitalization rate was 25% and mortality rate was 14.3%. The relationships according to the age groups revealed that all of the women were under the age of 50 (p=0.008) and the patients who deceased were male patients over the age of 50 (p=0.044). Conclusion: Mortality rates and intensive care unit requirements of chronically immunosuppressed liver transplant patients with COVID-19 infection were similar with general population. Complete immunosuppression withdrawal should not be urged in this population.

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“… 72 A review of 18 studies, including 1522 COVID-19 infected LT recipients, showed a similar risk of morbidity and mortality as compared to the general population. 73 Rabiee et al noted that change in immunosuppression during Covid infection was not associated with liver injury (mostly dose reduction of mycophenolate and calcineurin inhibitors). 74 Alanine transaminase (ALT) elevation was higher in post-transplant patients with Covid compared to the general population.…”

Section: Methodsmentioning

confidence: 99%

Outcomes in Patients with Liver Dysfunction Post SARS-CoV-2 Infection: What Should We Measure?

John,

Ibrahim,

Ebaid

et al. 2023

HMER

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Aim Since 2019, the COVID-19 pandemic wreaked havoc all over the world. Early in the course of the pandemic, multiple hepatic manifestations of COVID-19 were noted. We aim to categorize hepatic dysfunction and its outcome in COVID-19 infection. Methods This is a review article based on a literature search in PubMed and Medline databases for articles detailing short-term and long-term outcomes of COVID-19 related liver dysfunction. Results The most common hepatic manifestation of COVID-19 was aspartate amino transferase (AST) predominant transaminase elevation. Transaminases improve once the COVID-19 infection resolves. In addition, COVID-19 cholangiopathy, autoimmune hepatitis associated COVID-19, and splanchnic venous thrombosis triggered by COVID-19 are other manifestations. Patients with preexisting liver disease, especially those with cirrhosis, have poor prognosis with COVID-19 infections compared to the general population. Elevations in liver tests were associated with severe COVID-19 infections. Patients with chronic liver disease have a higher risk of morbidity and mortality from COVID-19 infection. Among patients with chronic liver disease, decompensated liver cirrhosis, hepatocellular carcinoma and alcohol-associated liver disease were associated with an increased risk of severity and mortality from COVID-19 infection. Interactions between antiviral therapy for COVID-19 and hepatitis B/hepatitis C medications must be considered in patients with chronic viral hepatitis and COVID-19 infection. COVID-19 vaccination-related hepatic dysfunction has been reported. Conclusion COVID-19 is here to stay. Hepatic dysfunction in COVID-19 signals severe COVID-19 infections. Patients with chronic liver disease have higher mortality from COVID-19 than general population. It is important to remember the lessons learned throughout the covid pandemic to take care of patients with COVID-19 now and in the future. Further studies are needed to document long-term outcomes in patients with COVID-19 who developed hepatic dysfunction.

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COVID-19 in liver transplant patients: Impact and considerations

Cited by 8 publications

References 44 publications

Monitoring tacrolimus toxicity following Paxlovid administration in a liver transplant patient

Monitoring tacrolimus toxicity following Paxlovid administration in a liver transplant patient

Outcomes of liver transplantation patients infected with COVID-19: pandemic hospital experience from Turkey

Outcomes in Patients with Liver Dysfunction Post SARS-CoV-2 Infection: What Should We Measure?

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