SARS-CoV-2 and Liver Transplant: How Has It Behaved in This Sixth Wave?

Abstract

Background. Since the declaration of a new variant of concern (VOC), Omicron, by the World Health Organization in November 2021, a quick spread has been documented worldwide, being the main VOC in the sixth wave in Spain. The Omicron variant has more transmissibility, lower virulence, and less risk of severe disease than previously described VOC. Here we analyze the current wave of severe acute respiratory syndrome coronavirus 2 infection in liver transplant recipients (LTRs). Methods. A retrospective observational study of 355 LTRs was conducted in La Rioja and Cantabria regions of Spain. Epidemiological and clinical parameters were gathered on the basis of clinical records and telephone interviews. Results. In the current wave of infection, a higher number of LTRs have been found to be infected than the sum of the previous 5 waves (30 versus 16 LTRs). Of the 30 infected LTRs, 29 (96.6%) had received 3 vaccine doses (mRNA based), in a median of 93 d (interquartile range, 86–108) before infection. Eight of 30 LTRs (24.0%) were asymptomatic and 21 LTRs (67.8%) were with mild symptoms with a mean duration of 4.6 d (interquartile range, 2.5–7), whereas in the unvaccinated LTRs, the symptoms were fever, nausea, vomiting, and diarrhea. Moreover, in the sixth wave, intrafamiliar transmission was the main route of infection (17/30; 56.6%), and nosocomial transmission was confirmed in 2 LTRs (6.6%). Conclusions. In our series, increased transmissibility of the Omicron variant was confirmed, including nosocomial infection, with a lower risk of severe disease in LTRs. These findings could be supported by the universal vaccination of LTRs and less virulence of the Omicron variant.

Clinical Outcomes of SARS-CoV-2 Breakthrough Infections in Liver Transplant Recipients during the Omicron Wave

“…However, 11.2% of LTR with breakthrough infections still required hospitalization for COVID-19-associated complications despite fulfilling the recommended vaccination status. These results are in line with mortality (2–10%) and hospitalization rates (3–56%) that were found in SOT [ 25 , 36 , 37 , 38 ] and a small Spanish single-center study that included 30 LTR with a hospitalization and mortality rate of 3.3% [ 25 ].…”

“…Whether the various subvariants lead to different clinical courses is not well known yet, and contradicting results were reported by different research groups [ 22 , 23 , 24 ]. There are only limited data available on the severity of the clinical course of COVID-19 [ 25 ], frequency of the development of long-lasting symptoms, and immune response in LTR with breakthrough infections during the Omicron wave.…”

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

“…53 Meanwhile, in the sixth wave of the epidemic, family transmission became the main mode of infection (intra-family transmission [17/30; 56.6%], intra-hospital transmission [6.6%]). 60,76 As time goes by, LT's activities are proceeding in an orderly manner. One positive SARS-CoV-2 LT in a patient with acute liver failure due to Wilson crisis has been successfully performed, and other studies have shown that LT surgery in positive patients can be performed after safety assessment.…”

“…However, it is a dangerous situation for decompensated LT patients remaining at home and lacking care 53 . Meanwhile, in the sixth wave of the epidemic, family transmission became the main mode of infection (intra‐family transmission [17/30; 56.6%], intra‐hospital transmission [6.6%]) 60,76 . As time goes by, LT's activities are proceeding in an orderly manner.…”