Clinical Presentation, Treatment, and Mortality Rate in Liver Transplant Recipients With Coronavirus Disease 2019: A Systematic Review and Quantitative Analysis

Abstract

Liver transplant recipients may be at increased risk for adverse outcomes with coronavirus disease 2019 (COVID-19) infection because of chronic immunosuppression and associated comorbidities. There is a paucity of literature describing clinical presentation, treatments, and outcomes in liver transplant recipients with COVID-19. A systematic search was performed for articles published up to June 15, 2020, revealing 223 liver transplant recipients with COVID-19 in 15 studies. Patients most commonly presented with fever (66.7%), dyspnea (34.0%), and diarrhea (28.4%). Of these, 77.7% required hospitalization, 24% had mild disease, 40% had moderate disease, and 36% had severe disease. Immunosuppression was modified in 32.8% of recipients. The case fatality rate was 19.3%. Dyspnea on presentation, diabetes mellitus, and age 60 years or older were significantly associated with increased mortality ( P ≤ .01) with a trend to higher mortality rate observed in those with hypertension and those receiving corticosteroids at the time of COVID-19 diagnosis. The median time from symptoms to death was 11.5 days (2-45 days). In conclusion, liver transplant recipients with severe acute respiratory syndrome coronavirus 2 are overrepresented with regard to severe disease and hospitalizations. Older liver transplant patients with diabetes mellitus or hypertension, who are on maintenance corticosteroids, with a diagnosis of COVID-19 and describing breathlessness should be aggressively monitored for signs of deterioration because of the risk for mortality.

Immunosuppression in chronic autoimmune neurological disorders during the COVID-19 pandemic

“…Impact of IST on the risk of COVID-19 and its outcome is not well studied. Some small scale single center studies on patients with other immunological disorders and/or immunosuppressed reported possible higher mortality rate [ 26 ] and more frequent hospitalization for patients on glucocorticoids [ 27 , 28 ]. However, several other single center [ 29 ] and multi-center cohort studies did not find any definitive detrimental effects of IST in terms of risk of COVID-19 and related complications [ 30 , 31 ].…”

COVID-19 in Chronic Liver Disease and Liver Transplantation

“… 8 Mortality from COVID-19 in patients with chronic liver diseases are often higher than those without liver disease (Table 1 ). 9 – 14 …”

Clinical Manifestations and Characterization of COVID-19 in Liver Transplant Recipients: A Systematic Review of Case Reports and Case Series

“…In this study, we assessed the clinical characteristics and epidemiologic features of case series and case report of liver transplant patients to gain a better understanding of the true risk of this complication caused by SARS CoV-2 in liver transplant recipients. The previous literature review and case series affirm the notion that COVID-19 disease occurs more severely in the receivers of solid organ transplants and are further disposed to hospital stay with greater fatality percentages due to COVID-19 compared to the patients without transplants (44,45). However, there are limited reviews on case reports about SOT patients (6,44).…”