Low prevalence and disease severity of COVID‐19 in post‐liver transplant recipients—A single centre experience

Verma, Anita; Khorsandi, Shirin Elizabeth; Dolcet, Annalisa; Prachalias, Andreas; Suddle, Abid; Heaton, Nigel; Jassem, Wayel

doi:10.1111/liv.14552

Cited by 29 publications

(54 citation statements)

References 15 publications

(35 reference statements)

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“…Published data on the course and outcome of COVID-19 in LT recipients is controversial and still evolving. Complications like pneumonia in COVID-19 are driven by abnormal immune response, therefore patients on immunosuppressive medications are likely to have a favorable outcome( 6 , 12 ). A recent study published by Webb et all, demonstrated that LT recipients are not at risk for higher mortality in SARS-CoV-2 infection( 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…(4) Initial studies suggested that patients on immunosuppressive medications such as, liver transplant recipients, are at increased risk of severe COVID-19 and mortality but subsequent evidence did not support this finding. (5,6) Although immunosuppression has risk of increased viral replication but on the other hand it may suppress immune dysregulation related cytokine storm in COVID-19. Data on SARS-CoV-2 infection in liver transplant J o u r n a l P r e -p r o o f recipients is very limited from India which is one of the worst affected country in this pandemic.…”

Section: Introductionmentioning

confidence: 99%

“…The data regarding impact of SARS-CoV-2 infection in post LT patients is conflicting and risk factors for outcome are also not well defined( 4 ). Initial studies suggested that patients on immunosuppressive medications such as, liver transplant recipients, are at increased risk of severe COVID-19 and mortality but subsequent evidence did not support this finding( 5 , 6 ). Although immunosuppression has risk of increased viral replication but on the other hand it may suppress immune dysregulation related cytokine storm in COVID-19.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

“SARS-CoV-2 Infection in Liver Transplant Recipients - Immunosuppression is the Silver Lining?”

Jaduan

Singh

Madan

et al. 2022

Journal of Clinical and Experimental Hepatology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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“SARS-CoV-2 Infection in Liver Transplant Recipients - Immunosuppression is the Silver Lining?”

Jaduan

Singh

Madan

et al. 2022

Journal of Clinical and Experimental Hepatology

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“…16 articles were included from manual searches. A total of 49 articles were nally included 16,[23][24][25][26][27][28][29][41][42][43][44][45][47][48][49][50][51][52][53][54][55][57][58][59][60][61][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82] . All studies involved in our analysis.…”

Section: Systematic Search and Its Resultsmentioning

confidence: 99%

Clinical Presentations and Outcomes in Transplant Patients With COVID-19: A Systematic Review and Meta-Analysis

Abbas

Shah

El-Sahat

et al. 2021

Preprint

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Introduction: Transplant patients are a vulnerable group due to their immunocompromised status. Understanding how COVID-19 can present in this group is clinically important. Therefore, we conduct a systematic review and meta-analysis on clinical features and management of transplant patients with COVID-19.Methods: Five databases were searched in May 2020 to include all relevant studies reporting clinical features or outcomes of COVID-19 infection in transplant patients. Data on clinical presentation, outcomes, lab values, imaging, and drug regimen were extracted. CMA software was used for meta-analysis. Protocol was registered in PROSPERO (CRD42020189458).Results: A total of 49 studies were finally included for analysis. Patients mainly complained from fever with event rate 74.40 % (95% CI= 69.4-78.8), cough 61.10% (95% CI= 55.8-66), and dyspnea 46.60% (95% CI= 69.4-78.8). Blood urea nitrogen 78.90% (95% CI= 54.7-92), ESR 78.10% (95% CI=52.3-92.1), and D-dimer 74.10% (95 % CI= 53-87.9) were the most elevated observed laboratory values. Ground glass opacities (GGO) were observed with event rate 68.10% (95% CI= 20.4-94.9). For treatment, immunosuppressants were used in 88.80% (95% CI= 77.6-94.8) of patients, followed by antibiotics and antiviral drugs 68.40% (95% CI= 52.4-80.9), 66.80% (95% CI = 45-83.2), respectively. Mechanical ventilation was used in 26.30% (95% CI=21-32.4) patients while 33.7% (95% CI= 20.7-49.9) intubated. Rejection occurred in 11% (95% CI= 4.4-25) of the patients. Finally, 18.20% (95% CI= 12.6-25.7) died. Conclusion: Clinical characteristics and management in transplant COVID patients suggest the similar course in non-transplant. Fever, cough, dyspnoea, elevated blood urea nitrogen level, elevated CRP, elevated d-dimer, GGO, and consolidation were found to be the most frequent abnormalities. No direct, comparative analysis with non-transplant COVID population limited our results; however, numerous studies that examined the infected general population found similar, less augmented findings. Most of the included sample were kidney transplant patients; therefore, more studies are needed to address other types of COVID-19 infected transplant patients.

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“…As of June 10, 2020, there are 244 reported cases of LT infected by COVID‐19, 3‐21 including 240 adult and 4 pediatric LT recipients (Table 1). So far, the available data are scarce, not homogeneous, and based mainly on case reports, correspondences, and letters to the editors; thus, the analysis and the interpretation of data must be cautious.…”

Section: Resultsmentioning

confidence: 99%

COVID‐19, liver transplant, and immunosuppression: Allies or foes?

Parente

Manzia

Angelico

et al. 2020

Transplant Infectious Dis

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Liver transplant (LT) recipients are considered at a particularly high risk for developing critical COVID‐19 infection. To date, available data are heterogeneous and scarce and mortality in LT recipients seems to be higher compared to normal population, but whether this is caused by altered immunological status, immunosuppression (IS), or underlying comorbidities has not yet been fully clarified. Some evidences show that IS might play a role in the pathophysiology of this new disease. We searched all available data regarding LT recipients infected by COVID‐19, focusing on the role of IS. To date, 244 LT recipients have been reported as COVID‐19‐positive. Trends among transplant physicians are to reduce overall IS, especially antimetabolite drugs, but the current available observations are still not enough to build strong evidences for recommendation and IS should be meticulously tailored case by case.

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Low prevalence and disease severity of COVID‐19 in post‐liver transplant recipients—A single centre experience

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 29 publications

References 15 publications

“SARS-CoV-2 Infection in Liver Transplant Recipients - Immunosuppression is the Silver Lining?”

“SARS-CoV-2 Infection in Liver Transplant Recipients - Immunosuppression is the Silver Lining?”

Clinical Presentations and Outcomes in Transplant Patients With COVID-19: A Systematic Review and Meta-Analysis

COVID‐19, liver transplant, and immunosuppression: Allies or foes?

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