COVID-19 in liver transplant recipients: incidence, hospitalization and outcome in an Italian prospective double-centre study

Abstract

Liver transplant (LT) recipients are vulnerable to SARS-CoV-2-infection (COVID-19), due to immunosuppression and comorbidities. This study aimed to evaluate the impact of COVID-19 on LT recipients compared to general population in the Campania region. In this prospective double-centre study, we enrolled all consecutive adult LT recipients with confirmed SARS-CoV-2-infection. Data were collected at diagnosis of COVID-19 and during follow-up and compared with the regional population. Thirty LT recipients (3.28%) developed SARS-CoV-2-infection (76.66% male, median age 62.61 years). Sixteen (53.33%) were symptomatic. Common symptoms were fever, cough, fatigue, and anosmia. Twenty-five (83.33%) were outpatients, 5 (16.66%) required hospitalization (6.66% admitted to Intensive Care Unit, 6.62% developed Acute Respiratory Distress Syndrome and 6.66% died). Immunosuppressors were in 3 (10%) patients. Incidence rate of COVID-19 was similar between LT patients and general population (3.28% vs 4.37%, p = 0.142) with higher rate of symptoms in LT patients (53.33% vs 15.87%, p < 0.000). At univariate analysis, hospitalization and case fatality rates were higher in LT patients compared to general population (16.66% vs 4.54%, p = 0.001; and 6.66% vs 1.76%, p = 0.041, respectively). At multivariable logistic regression analysis, LT patients with COVID-19 were more frequently symptomatic (OR 5.447 [95% CI 2.437–12.177], p < 0.000), whereas hospitalization and death for COVID-19 were not significatively associated with LT condition (p = 0.724 and p = 0.462, respectively) and were comparable with general population. LT is not a risk factor for acquiring COVID-19. Nonetheless, LT patients are more frequently symptomatic, although comparable to the general population for hospitalization rate and mortality.

Successful liver transplantation in patients with active SARS-CoV-2 infection

“… 13 Another matched cohort study found that solid organ transplant recipients with COVID‐19 had similar mortality rates as non‐transplant patients, 14 while a prospective Italian study found that LT was not associated with increased risk of hospitalization or death due to COVID‐19. 15 Data on the importance of immunization status are not available but we believe that recipients should be vaccinated prior to undergoing transplantation. The decision to proceed with LT in a COVID‐19–positive recipient should, therefore, be made cautiously while weighing age, severity of COVID‐19 illness, and additional comorbidities rather than immunosuppression status.…”

“…However, a recent literature review concluded that age and comorbidities are more significant risk factors for COVID‐19 severity than immunosuppression status 13 . Another matched cohort study found that solid organ transplant recipients with COVID‐19 had similar mortality rates as non‐transplant patients, 14 while a prospective Italian study found that LT was not associated with increased risk of hospitalization or death due to COVID‐19 15 . Data on the importance of immunization status are not available but we believe that recipients should be vaccinated prior to undergoing transplantation.…”

COVID-19 in liver transplant patients: Impact and considerations

“…The Spanish Society of Liver Transplantation found that liver transplant recipients may have double the risk of acquiring COVID-19 within an epidemic scenario (standardized incidence ratio: 191.2; 95%CI: 190.3-192.2) as compared to an age and sex-matched cohort[ 46 ]. A 2022 prospective double-center study from southern Italy followed 30 liver transplant recipients who were infected with COVID-19 and found that liver transplant recipients were more often symptomatic but did not have an increased risk for hospitalization or mortality[ 47 ].…”

Liver transplantation amidst the COVID-19 era: Our center’s experience

“…The Spanish Society for Liver Transplantation conducted a prospective nationwide study that included 111 LT recipients and concluded that these patients were twice as likely to be infected with COVID-19 compared to age- and sex-matched individuals (standardized incidence: 191.2; 95% confidence interval: 190.3-192.2)[ 23 ]. However, another prospective study from Italy followed 30 LT recipients with COVID-19 and suggested that LT recipients were more symptomatic yet with no increased risk of hospitalization or death[ 24 ].…”