A Report of 85 Cases of COVID-19 and Abdominal Transplantation From a Single Center: What Are the Associated Factors With Death Among Organ Transplantation Patients

Abstract

Background. In this study, we report the epidemiology of COVID-19 among recipients of organ transplantation and evaluate associated factors with death. Methods. We screened 6969 patients who had organ transplantations in our center for COVID-19. Specific data on presentation, clinical course, treatment, and prognosis were acquired. Results. We found 85 patients (66 liver, 16 kidney, 2 kidney-pancreas, and 1 liver-kidney recipient) who acquired COVID-19. Most common symptoms included fever (48.2%), cough (41.2%), myalgia (41.2%), and fatigue (40%). Dyspnea developed in 33% of patients. Overall, one-third of patients had an oxygen saturation of below 90% on admission. Patients were hospitalized for a median (interquartile range) of 9 (5, 13.7) days and had a 33.9% intensive care unit admission rate. Overall, 17 patients (20%) died, which included 31.3% of patients with kidney transplantations and 18.2% of patients with liver transplantations. All 4 pediatric patients in our series died. In our univariate analysis among adults, rates of leukopenia (38.4% versus 13.2%; P = 0.04), low albumin levels (53.8% versus 10.2%; P = 0.001), and shorter duration between transplantation and COVID-19 (P = 0.02), were higher among patients who died. In our least absolute shrinkage and selection operator regression model, low albumin levels (OR, 4.48; 95% confidence interval, 1.16-17.27) were associated with higher risk of death. Conclusions. This is the largest single-center report on abdominal transplantations and COVID-19. Liver and kidney transplant recipients have an increased risk of mortality compared with the general population due to COVID-19. More specifically, pediatric patients and those with low albumin levels are at higher risks of death due COVID-19.

Impact of COVID-19 on liver transplant recipients–A systematic review and meta-analysis

“…Therefore, a total of 18 articles reporting 1522 patients were included for the systematic review and meta-analysis. [ 16 , 17 , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] ] (Supplementary file 2: Excluded case reports and other language articles).

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“…Gender and age were not reported in four studies [31] , [32] , [33] , [34] . All patients had positive polymerase chain reaction (PCR) tests, except five studies including patients with classical symptoms and CT features suggestive of COVID-19 (Appendix II) [ [25] , [26] , [27] , 32 , 37 ]. Only 14 asymptomatic patients were detected to be PCR positive when screened for hospital admission or prior to a planned procedure (or surgery) or after a contact exposure [ 22 , 23 , 28 , 35 ].…”

“…The aetiology of liver disease was reported in nine studies and 855 LT recipients. [ 17 , [22] , [23] , [24] , [25] , 27 , 29 , 30 , 37 ] The most common aetiology was viral (38%, 318/855), followed by alcohol-related liver disease (22·23%, 190/855), NASH (8·5%, 72/855), autoimmune liver disease (7·4%, 63/855), and HCC (5·26%, 45/855). Other causes contributed to 18·5% (158/855) of aetiologies, and lastly, 8·2% (70/855) of patients had concomitant HCC.…”

Liver injury in COVID-19: clinical features and treatment management

“…Severe lung lesions were more likely to cause liver dysfunction [ 6 ]. Another study [ 16 ] showed that among the COVID-19 patients who received organ transplantation, the ICU admission rate was as high as 33.3%, and 20% of patients died. It can be seen that the death risk of liver and kidney transplantation patients is increased.…”

Tacrolimus Use and COVID-19 Infection in Patients After Solid Organ Transplantation

“…5 Finally, 11 cohort studies were included. [1][2][3][4][6][7][8][9][10][11][12] Among them, 7 studies involving 1348 SOT patients explored the association between tacrolimus use and mortality and other 4 involving 229 SOTs explored the association between tacrolimus use and severe COVID-19 (Supplementary Table 1). Four studies only included hospitalized patients, and 7 included both in-and out-patients.…”