Dataset Information

Epidemiological pattern, incidence, and outcomes of COVID-19 in liver transplant patients.

ABSTRACT:

Background & aims

The incidence and outcomes of coronavirus disease 2019 (COVID-19) in immunocompromised patients are a matter of debate.

Methods

We performed a prospective nationwide study including a consecutive cohort of liver transplant patients with COVID-19 recruited during the Spanish outbreak from 28 February to 7 April, 2020. The primary outcome was severe COVID-19, defined as the need for mechanical ventilation, intensive care, and/or death. Age- and gender-standardised incidence and mortality ratios (SIR and SMR) were calculated using data from the Ministry of Health and the Spanish liver transplant registry. Independent predictors of severe COVID-19 among hospitalised patients were analysed using multivariate Cox regression.

Results

A total of 111 liver transplant patients were diagnosed with COVID-19 (SIR = 191.2 [95% CI 190.3-192.2]). The epidemiological curve and geographic distribution overlapped widely between the liver transplant and general populations. After a median follow-up of 23 days, 96 patients (86.5%) were admitted to hospital and 22 patients (19.8%) required respiratory support. A total of 12 patients were admitted to the ICU (10.8%). The mortality rate was 18%, which was lower than in the matched general population (SMR = 95.5 [95% CI 94.2-96.8]). Overall, 35 patients (31.5%) met criteria of severe COVID-19. Baseline immunosuppression containing mycophenolate was an independent predictor of severe COVID-19 (relative risk = 3.94; 95% CI 1.59-9.74; p = 0.003), particularly at doses higher than 1,000 mg/day (p = 0.003). This deleterious effect was not observed with calcineurin inhibitors or everolimus and complete immunosuppression withdrawal showed no benefit.

Conclusions

Being chronically immunosuppressed, liver transplant patients have an increased risk of acquiring COVID-19 but their mortality rates are lower than the matched general population. Upon hospital admission, mycophenolate dose reduction or withdrawal could help in preventing severe COVID-19. However, complete immunosuppression withdrawal should be discouraged.

Lay summary

In liver transplant patients, chronic immunosuppression increases the risk of acquiring COVID-19 but it could reduce disease severity. Complete immunosuppression withdrawal may not be justified. However, mycophenolate withdrawal or temporary conversion to calcineurin inhibitors or everolimus until disease resolution could be beneficial in hospitalised patients.

SUBMITTER: Colmenero J

PROVIDER: S-EPMC7395653 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Publications

Epidemiological pattern, incidence, and outcomes of COVID-19 in liver transplant patients.

Colmenero Jordi J Rodríguez-Perálvarez Manuel M Salcedo Magdalena M Arias-Milla Ana A Muñoz-Serrano Alejandro A Graus Javier J Nuño Javier J Gastaca Mikel M Bustamante-Schneider Javier J Cachero Alba A Lladó Laura L Caballero Aránzazu A Fernández-Yunquera Ainhoa A Loinaz Carmelo C Fernández Inmaculada I Fondevila Constantino C Navasa Miquel M Iñarrairaegui Mercedes M Castells Lluis L Pascual Sonia S Ramírez Pablo P Vinaixa Carmen C González-Dieguez María Luisa ML González-Grande Rocío R Hierro Loreto L Nogueras Flor F Otero Alejandra A Álamo José María JM Blanco-Fernández Gerardo G Fábrega Emilio E García-Pajares Fernando F Montero José Luis JL Tomé Santiago S De la Rosa Gloria G Pons José Antonio JA

Journal of hepatology 20200801 1

<h4>Background & aims</h4>The incidence and outcomes of coronavirus disease 2019 (COVID-19) in immunocompromised patients are a matter of debate.<h4>Methods</h4>We performed a prospective nationwide study including a consecutive cohort of liver transplant patients with COVID-19 recruited during the Spanish outbreak from 28 February to 7 April, 2020. The primary outcome was severe COVID-19, defined as the need for mechanical ventilation, intensive care, and/or death. Age- and gender-standardised ...[more]

PMID: 32750442

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Dataset Information

Epidemiological pattern, incidence, and outcomes of COVID-19 in liver transplant patients.

Background & aims

Methods

Results

Conclusions

Lay summary

Publications

Epidemiological pattern, incidence, and outcomes of COVID-19 in liver transplant patients.

Similar Datasets

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