COVID-19 in liver transplant recipients: preliminary data from the ELITA/ELTR registry

Belli, Luca; Duvoux, Christophe; Karam, Vincent; Adam, René; Cuervas-Mons, Valentín; Pasulo, L.; Loinaz, Carmelo; Invernizzi, Federica; Patrono, Damiano; Bhoori, Sherrie; Ciccarelli, Olga; Morelli, Cristina; Castells, L.; López-López, Víctor; Conti, Sara; Fondevila, Constantino; Polak, Wojciech

doi:10.1016/s2468-1253(20)30183-7

Cited by 75 publications

(130 citation statements)

References 4 publications

(1 reference statement)

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“…28,29 Early reports from Italy described low mortality rates in transplant recipients <5%, 20,30 however subsequent analyses have reported mortality rates in liver and other solid organ transplant recipients at around 25%. 28,[31][32][33][34] The results of a prospective European study from 19 transplant centres were recently reported, 35 including 57 liver transplant (LT) recipients with confirmed SARS-CoV-2 infection. Overall and in-hospital case-fatality rates were 12% and 17%, respectively, which are similar to the expected mortality for patients with severe COVID-19 infection.…”

Section: Liver Transplantation Recipientsmentioning

confidence: 99%

“…19 Similarly, patients on maintenance glucocorticoids for rheumatological conditions have an increased rate of hospitalisation following SARS-CoV-2 infection. 59 As yet, small case series have been unable to draw definitive conclusions regarding the risks posed by corticosteroid use in patients with autoimmune hepatitis or after LT. 31,34 In these patients, the risks of hepatitis flares or graft rejection must be weighed against the potential risks of developing severe COVID-19. Currently, we advise against routine reduction of immunosuppression in patients with autoimmune hepatitis or LT recipients, including the use of steroids if required.…”

Section: Corticosteroidsmentioning

confidence: 99%

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Impact of COVID-19 on the care of patients with liver disease: EASL-ESCMID position paper after 6 months of the pandemic

et al. 2020

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During the early stages of the coronavirus disease 2019 (COVID-19) pandemic, EASL and ESCMID published a position paper to provide guidance for physicians involved in the care of patients with chronic liver disease. While some healthcare systems are returning to a more normal routine, many countries and healthcare systems have been, or still are, overwhelmed by the pandemic, which is significantly impacting on the care of these patients. In addition, many studies have been published focusing on how COVID-19 may affect the liver and how pre-existing liver diseases might influence the clinical course of COVID-19. While many aspects remain poorly understood, it has become increasingly evident that pre-existing liver diseases and liver injury during the disease course must be kept in mind when caring for patients with COVID-19. This review should serve as an update on the previous position paper, summarising the evidence for liver disease involvement during COVID-19 and providing recommendations on how to return to routine care wherever possible.

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Section: Liver Transplantation Recipientsmentioning

confidence: 99%

Section: Corticosteroidsmentioning

confidence: 99%

Impact of COVID-19 on the care of patients with liver disease: EASL-ESCMID position paper after 6 months of the pandemic

et al. 2020

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“…Isolated case reports from China have described COVID-19 in liver transplant recipients with successful outcomes [81]. To date, the largest study (n = 103) in LT recipients with COVID-19 comes from the European Liver Transplant Registry (ELTR), which reported a mortality rate of 16% [82]. Of the 103 patients, 83 patients were hospitalized including 15 in the ICU.…”

Section: Post-transplant Patientsmentioning

confidence: 99%

What GI Physicians Need to Know During COVID-19 Pandemic

2020

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The worldwide pandemic of COVID-19, caused by the virus SARS-CoV-2, continues to cause significant morbidity and mortality in both low-and high-income countries. Although COVID-19 is predominantly a respiratory illness, other systems including gastrointestinal (GI) system and liver may be involved because of the ubiquitous nature of ACE-2 receptors in various cell lines that SARS-CoV-2 utilizes to enter host cells. It appears that GI symptoms and liver enzyme abnormalities are common in COVID-19. The involvement of the GI tract and liver correlates with the severity of disease. A minority (10-20%) of patients with COVID-19 may also present initially with only GI complaints. The most common GI symptoms are anorexia, loss of smell, nausea, vomiting, and diarrhea. Viral RNA can be detected in stool in up to 50% of patients, sometimes even after pharyngeal clearance, but it is unclear whether fecal-oral transmission occurs. Liver enzymes are elevated, usually mild (2-3 times), in a substantial proportion of patients. There are many confounding factors that could cause liver enzyme abnormalities including medications, sepsis, and hypoxia. Although infection rates in those with preexisting liver disease are similar to that of general population, once infected, patients with liver disease are more likely to have a more severe disease and a higher mortality. There is a paucity of objective data on the optimal preventive or management strategies, but few recommendations for GI physicians based on circumstantial evidence are discussed.

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“…Transplantation Association have reported one of the largest cohorts (103 cases) so far. 3 Mortality was observed only in patients aged 60 years or older and was more common in men. In addition, Webb et al have summarised details of 39 LT recipients who developed COVID-19, based on two collaborating international registries (SECURE Cirrhosis and COVIDHep).…”

Section: Liver Transplant Registry and The European Liver And Intestinementioning

confidence: 99%

Letter: unknown denominator and misleading conclusions in Covid‐19—authors' reply

Garrido

Liberal

Macedo

2020

Aliment Pharmacol Ther

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COVID-19 in liver transplant recipients: preliminary data from the ELITA/ELTR registry

Cited by 75 publications

References 4 publications

Impact of COVID-19 on the care of patients with liver disease: EASL-ESCMID position paper after 6 months of the pandemic

Impact of COVID-19 on the care of patients with liver disease: EASL-ESCMID position paper after 6 months of the pandemic

What GI Physicians Need to Know During COVID-19 Pandemic

Letter: unknown denominator and misleading conclusions in Covid‐19—authors' reply

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