Outcome of COVID‐19 in liver transplant recipients: A preliminary report from Northwestern Italy

Abstract

Covid-19 pandemic is deeply affecting transplant activity worldwide. It is unclear whether solid organ transplant recipients are at increased risk of developing severe complications and how they should be managed, also concerning immunosuppression. This is a report about the course and management of SARS-CoV-2 infection in liver transplant recipients from a single center in Northwestern Italy in the period March-April 2020. Three patients who were treated at our institution are reported in detail, whereas summary data are provided for those managed at peripheral Hospitals. Presentation varied from asymptomatic to rapidly progressive respiratory failure due to bilateral interstitial pneumonia. Accordingly, treatment and changes to immunosuppression were adapted to the severity of the disease. Overall mortality was 20%, whereas Covid-related mortality was 10%. Two cases of prolonged (>2 months) viral carriage were observed in two asymptomatic patients who contracted the infection in the early course after transplant. Besides depicting Covid-19 course and possible treatment scenarios in liver transplant patients, these cases are discussed in relation to the changes in our practice prompted by Covid-19 epidemic, with potential implications for other transplant programs.

COVID‐19, liver transplant, and immunosuppression: Allies or foes?

“…Notably, in this large case series the mortality rate was higher among patients with a follow‐up ≥2 years from LT 19 . This trend is confirmed by other reports, 4,18 but the underlying reasons remain unclear. One potential explanation could be the longer exposure to IS therapy, a known risk factor for developing IS‐related complications such as hypertension or diabetes that might play a role in increasing the mortality risk for COVID‐19.…”

“…As of June 10, 2020, there are 244 reported cases of LT infected by COVID‐19, 3‐21 including 240 adult and 4 pediatric LT recipients (Table 1). So far, the available data are scarce, not homogeneous, and based mainly on case reports, correspondences, and letters to the editors; thus, the analysis and the interpretation of data must be cautious.…”

COVID-19 in immunocompromised patients: A systematic review of cancer, hematopoietic cell and solid organ transplant patients

“…To be included, the study must have reported clinical data on adult (A-CA) or pediatric (P-CA) cancer patients and SOT or HCT recipients with confirmed COVID-19. Our inclusion and exclusion criteria identified 64 SOT studies, 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 11 HCT studies,…”

Enfermedad hepática y trasplante durante la pandemia COVID-19/SARS-CoV-2

“…[62][63][64] En los pacientes con manifestaciones menores, se recomienda continuar con el esquema de inmunosupresión habitual. 67 1 63.0 10.0 0 0.0 0.0 Zhong et al 68 1 37.0 9 días 0 0.0 0.0 Tschopp et al 69 5 56.0 47 meses ND 0.0 0.0 Gao et al 70 73 1 80.0 14.2 ND 0.0 0.0 Müller et al 74 1 55.0 1.0 100 0.0 0.0 Yi et al 75 3 54.8 5.5 90 33.3 0.0 Modi et al 76 1 32.0 7.0 100 0.0 0.0 Patrono et al 77 10 65.6 7.0 ND 20 10 Massoumi et al 44 5 48.6 42.2 días ND 0.0 0.0 Massoumi et al 44 9 ND ND ND 33.3 0.0 Belli et al 78 103 65.0 ND > 56 37 16 ND = no disponible. * Promedio en series de caso.…”