Impact of SARS-CoV-2 Pandemic on the Management of Patients with Hepatocellular Carcinoma

Guarino, Maria; Cossiga, Valentina; Capasso, Mario; Mazzarelli, Chiara; Pelizzaro, Filippo; Sacco, Rodolfo; Russo, Francesco Paolo; Vitale, Alessandro; Trevisani, Franco; Cabibbo, Giuseppe; group, on behalf of the EMPA-KIDNEY collaborative

doi:10.3390/jcm11154475

Cited by 8 publications

(7 citation statements)

References 83 publications

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“…Similar to outpatient management of other cancers, challenges in care of HCC were prompted by overall disruption of healthcare during COVID-19[ 10 , 11 ]. Despite efforts to optimize care, there was an overall reduction in HCC surveillance and subsequent treatment during the early COVID pandemic[ 12 - 14 ]. Because of the unknown risk-benefit of proceeding with liver transplantation and introducing iatrogenic immune-suppression, liver transplantation was limited to patients who had higher risk of imminent death while on the waitlist[ 1 , 2 ].…”

Section: Discussionmentioning

confidence: 99%

Inferior outcomes of liver transplantation for hepatocellular carcinoma during early-COVID-19 pandemic in the United States

Lee¹,

Okumura²,

Misawa³

et al. 2023

World J Hepatol

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BACKGROUND Early in the coronavirus disease 2019 (COVID-19) pandemic, there was a significant impact on routine medical care in the United States, including in fields of transplantation and oncology. AIM To analyze the impact and outcomes of early COVID-19 pandemic on liver transplantation (LT) for hepatocellular carcinoma (HCC) in the United States. METHODS WHO declared COVID-19 as a pandemic on March 11, 2020. We retrospectively analyzed data from the United Network for Organ Sharing (UNOS) database regarding adult LT with confirmed HCC on explant in 2019 and 2020. We defined pre-COVID period from March 11 to September 11, 2019, and early-COVID period as from March 11 to September 11, 2020. RESULTS Overall, 23.5% fewer LT for HCC were performed during the COVID period (518 vs 675, P < 0.05). This decrease was most pronounced in the months of March-April 2020 with a rebound in numbers seen from May-July 2020. Among LT recipients for HCC, concurrent diagnosis of non-alcoholic steatohepatitis significantly increased (23 vs 16%) and alcoholic liver disease (ALD) significantly decreased (18 vs 22%) during the COVID period. Recipient age, gender, BMI, and MELD score were statistically similar between two groups, while waiting list time decreased during the COVID period (279 days vs 300 days, P = 0.041). Among pathological characteristics of HCC, vascular invasion was more prominent during COVID period ( P < 0.01), while other features were the same. While the donor age and other characteristics remained same, the distance between donor and recipient hospitals was significantly increased ( P < 0.01) and donor risk index was significantly higher (1.68 vs 1.59, P < 0.01) during COVID period. Among outcomes, 90-day overall and graft survival were the same, but 180-day overall and graft were significantly inferior during COVID period (94.7 vs 97.0%, P = 0.048). On multivariable Cox-hazard regression analysis, COVID period emerged as a significant risk factor of post-transplant mortality (Hazard ratio 1.85; 95%CI: 1.28-2.68, P = 0.001). CONCLUSION During COVID period, there was a significant decrease in LTs performed for HCC. While early postoperative outcomes of LT for HCC were same, the overall and graft survival of LTs for HCC after 180 days were significantly inferior.

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Section: Discussionmentioning

confidence: 99%

Inferior outcomes of liver transplantation for hepatocellular carcinoma during early-COVID-19 pandemic in the United States

Lee¹,

Okumura²,

Misawa³

et al. 2023

World J Hepatol

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“…Despite the fact that the analysis of the humoral response in cirrhotic subgroups (compensated vs. decompensated cirrhotic patients, patients without CSPH vs. those with CSPH, and patients without HCC vs. those with HCC) showed no statistical significance, we noticed that our results lean toward the differences between these subgroups. The smallness of sample size was the main determining factor in the analysis, and a statistic significance should be obtained with a larger sample, as reported in a prospective multicenter study [ 29 ], in which Jitao W. et al described the humoral hyporesponsiveness to COVID-19 vaccination in decompensated cirrhotic patients (Child–Pugh scores B and C) and in HCC patients [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Safety and Immunogenicity of Anti-SARS-CoV-2 Booster Dose in Patients with Chronic Liver Disease

Cossiga

Capasso

Guarino

et al. 2023

JCM

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The low response to vaccines is a well-known problem in cirrhosis. We evaluated the safety and immunogenicity of booster doses in patients with chronic liver disease (CLD), comparing the humoral response in cirrhotic vs. non-cirrhotic patients, and the impact of different factors on immune response. From September 2021 to April 2022, outpatients with CLD who completed the primary vaccination course and the booster dose against SARS-CoV-2 were enrolled. Blood samples were collected after second and third doses for detecting anti-spike protein IgG. We enrolled 340 patients; among them, 91 subjects were cirrhotic. After primary vaccination course, 60 (17.6%) patients did not develop a positive antibody titer, without significant differences between cirrhotic and non-cirrhotic patients (p = 0.076); most of them (88.3%) developed it after booster dose. At multivariable analysis, factors associated with higher humoral response after booster dose were only porto-sinusoidal vascular disorder (p = 0.007) as an etiology of CLD and the use of the mRNA-1273 vaccine (p = 0.001). In conclusion, in patients with CLD, a booster dose against SARS-CoV-2 induces an excellent immunogenicity and leads to an adequate antibody response. Cirrhosis is not associated with a worse humoral response, compared to patients with non-cirrhotic CLD.

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“…COVID-19 in HCC patients tends to be more severe and leads to exacerbation of the liver disease[ 79 ]. HCC patients infected with COVID-19 are at a higher risk of complications, ICU admission, and death than the patients without cancer[ 80 ].…”

Section: Covid-19 In Patients With Pre-existing Liver Diseasementioning

confidence: 99%

Outcomes of COVID-19 among patients with liver disease

Vujčić¹

2023

World J Gastroenterol

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Coronavirus disease 2019 (COVID-19) is primarily a respiratory disease with multi-organ involvement, including impaired liver function. It has been noticed that a significant proportion of COVID-19 patients have liver dysfunction, especially those with a more severe disease course. The coronavirus causes direct damage to the liver using the angiotensin-converting enzyme 2, a cell-surface receptor for cellular entry, that is expressed in the liver. According to previous research, liver enzyme abnormalities were observed in a considerable proportion of COVID-19 patients, and elevated liver transaminases were found in about 20% of these patients, alkaline phosphatase in 6.1%, and gamma-glutamyl transferase in 21.1%. COVID-19 might trigger a deterioration of liver function in patients with pre-existing chronic liver diseases (CLDs) and also in those without previous liver disorders. The majority of COVID-19 patients who develop liver injury are men, the elderly, and those with a higher body mass index. Compared to the general population, COVID-19 is associated with significant morbidity and mortality in patients with liver disease (cirrhosis and liver transplantation recipients). However, some studies indicate that CLDs have a lesser role in determining patient progression towards higher disease severity.

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Impact of SARS-CoV-2 Pandemic on the Management of Patients with Hepatocellular Carcinoma

Cited by 8 publications

References 83 publications

Inferior outcomes of liver transplantation for hepatocellular carcinoma during early-COVID-19 pandemic in the United States

Inferior outcomes of liver transplantation for hepatocellular carcinoma during early-COVID-19 pandemic in the United States

Safety and Immunogenicity of Anti-SARS-CoV-2 Booster Dose in Patients with Chronic Liver Disease

Outcomes of COVID-19 among patients with liver disease

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