COVID-19 in liver transplant recipients

Piedade, Juliana; Pereira, Gustavo

doi:10.1016/j.liver.2021.100026

Cited by 7 publications

(8 citation statements)

References 44 publications

(65 reference statements)

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“…Most LT recipients have radiological evidence of COVID-19 on chest computed tomography (contrast or non-contrast) or X-rays and are symptomatic, with a possible impact of immunosuppressants[ 21 - 24 ]. Fever, cough, dyspnea, fatigue, and myalgia were the most frequently reported symptoms at the time of diagnosis, just like in the general population, with fever and cough being the two most frequently reported symptoms[ 25 - 29 ] and anosmia and dysgeusia the least reported[ 14 ]. A significant variation in the incidence of gastrointestinal symptoms in COVID-19 (ranging from 3% to 79%) has been reported[ 30 ], with rates between 5% and 15% in two large-scale studies[ 31 , 32 ].…”

Section: Clinical Picturementioning

confidence: 99%

“…Two approaches have been prioritized for the management of LT recipients infected with COVID-19: (1) Reducing or discontinuing immunosuppressive medications used to prevent allograft rejection; and (2) Using antiviral (such as remdesivir), anti-inflammatory (such as high-dose corticosteroids), and immunomodulatory therapies (such as tocilizumab), as indicated in general populations[ 14 ]. Immunosuppression management and its effect on COVID-19 outcomes present significant challenges[ 51 ].…”

Section: Covid-19 Treatment In Lt Recipientsmentioning

confidence: 99%

“…SARS-CoV-2, like other RNA respiratory viruses, can cause atypical and attenuated infection symptoms in immunosuppressed patients, frequently resulting in delayed presentations and missed diagnoses[ 13 ]. It is crucial to recognize COVID-19 infection in this population to guide immunosuppressive management, prognosis, and prophylaxis in this disease associated with high morbidity/mortality[ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis, treatment protocols, and outcomes of liver transplant recipients infected with COVID-19

Hashem¹,

El-Kassas²

2023

World J Clin Cases

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Several cases of fatal pneumonia during November 2019 were linked initially to severe acute respiratory syndrome coronavirus 2, which the World Health Organization later designated as coronavirus disease 2019 (COVID-19). The World Health Organization declared COVID-19 as a pandemic on March 11, 2020. In the general population, COVID-19 severity can range from asymptomatic/mild symptoms to seriously ill. Its mortality rate could be as high as 49%. The Centers for Disease Control and Prevention have acknowledged that people with specific underlying medical conditions, among those who need immunosuppression after solid organ transplantation (SOT), are at an increased risk of developing severe illness from COVID-19. Liver transplantation is the second most prevalent SOT globally. Due to their immunosuppressed state, liver transplant (LT) recipients are more susceptible to serious infections. Therefore, comorbidities and prolonged immunosuppression among SOT recipients enhance the likelihood of severe COVID-19. It is crucial to comprehend the clinical picture, immunosuppressive management, prognosis, and prophylaxis of COVID-19 infection because it may pose a danger to transplant recipients. This review described the clinical and laboratory findings of COVID-19 in LT recipients and the risk factors for severe disease in this population group. In the following sections, we discussed current COVID-19 therapy choices, reviewed standard practice in modifying immunosuppressant regimens, and outlined the safety and efficacy of currently licensed drugs for inpatient and outpatient management. Additionally, we explored the clinical outcomes of COVID-19 in LT recipients and mentioned the efficacy and safety of vaccination use.

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Section: Clinical Picturementioning

confidence: 99%

Section: Covid-19 Treatment In Lt Recipientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnosis, treatment protocols, and outcomes of liver transplant recipients infected with COVID-19

Hashem¹,

El-Kassas²

2023

World J Clin Cases

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“…66 Generally, discontinuation of MMF and continued use of tacrolimus or everolimus is a more favorable therapy. 67 More importantly, the use of immunosuppressants during the pandemic needs cautious to achieve a balance between antiviral and anti-transplant rejection. 16,68 Several studies has indicated that the severity of COVID-19 in shortterm LT patients is lower than that of long-term LT patients.…”

Section: Acetaminophenmentioning

confidence: 99%

COVID‐19‐associated liver injury: Adding fuel to the flame

Wang,

Shen,

et al. 2023

Cell Biochemistry & Function

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COVID‐19 is mainly characterized by respiratory disorders and progresses to multiple organ involvement in severe cases. With expansion of COVID‐19 and SARS‐CoV‐2 research, correlative liver injury has been revealed. It is speculated that COVID‐19 patients exhibited abnormal liver function, as previously observed in the SARS and MERS pandemics. Furthermore, patients with underlying diseases such as chronic liver disease are more susceptible to SARS‐CoV‐2 and indicate a poor prognosis accompanied by respiratory symptoms, systemic inflammation, or metabolic diseases. Therefore, COVID‐19 has the potential to impair liver function, while individuals with preexisting liver disease suffer from much worse infected conditions. COVID‐19 related liver injury may be owing to direct cytopathic effect, immune dysfunction, gut−liver axis interaction, and inappropriate medication use. However, discussions on these issues are infancy. Expanding research have revealed that angiotensin converting enzyme 2 (ACE2) expression mediated the combination of virus and target cells, iron metabolism participated in the virus life cycle and the fate of target cells, and amino acid metabolism regulated immune response in the host cells, which are all closely related to liver health. Further exploration holds great significance in elucidating the pathogenesis, facilitating drug development, and advancing clinical treatment of COVID‐19‐related liver injury. This article provides a review of the clinical and laboratory hepatic characteristics in COVID‐19 patients, describes the etiology and impact of liver injury, and discusses potential pathophysiological mechanisms.

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“…There has been significant concern about the increased susceptibility to SARS-CoV-2 infection among solid organ transplant recipients. In a systematic review by Piedade and Pereira[ 12 ], patients with liver transplant were not associated with an increased risk of SARS-CoV-2 infection. The risk is highly dependent on the sex, age, body mass index, history of hepatocellular carcinoma, and the immunosuppression drug dose of the patient.…”

Section: High Risk Populations Of Sars-cov-2-induced Liver Injurymentioning

confidence: 99%

SARS-CoV-2-induced liver injury: A review article on the high-risk populations, manifestations, mechanisms, pathological changes, management, and outcomes

Payus¹,

Noh²,

Azizan³

et al. 2022

World J Gastroenterol

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The novel coronavirus disease 2019 is an infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was declared a global pandemic with more than 500 million reported cases and more than 6 million deaths worldwide to date. Although it has transitioned into the endemic phase in many countries, the mortality rate and overall prognosis of the disease are still abysmal and need further improvement. There has been evidence that shows the significance of SARS-CoV-2-related liver injury. Here, we review the literature on the various spectrum of SARS-CoV-2 infection-induced liver injury and the possible mechanisms of damage to the hepatobiliary system. This review aimed to illustrate the latest understanding regarding SARS-CoV-2-induced liver injury including the high-risk populations, the characteristic clinical manifestations, the possible pathogenic mechanism, the pathological changes, the current suggestions for clinical treatment for various spectrum of populations, and the prognosis of the condition. In conclusion, SARS-CoV-2 patients with a liver injury warrant close monitoring as it is associated with the more severe and poorer outcome of the infection.

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COVID-19 in liver transplant recipients

Cited by 7 publications

References 44 publications

Diagnosis, treatment protocols, and outcomes of liver transplant recipients infected with COVID-19

Diagnosis, treatment protocols, and outcomes of liver transplant recipients infected with COVID-19

COVID‐19‐associated liver injury: Adding fuel to the flame

SARS-CoV-2-induced liver injury: A review article on the high-risk populations, manifestations, mechanisms, pathological changes, management, and outcomes

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