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Covid-19 impact on liver transplantation recipients

Authors

  • André Carmo Faculty of Medicine, University of Coimbra, University of Coimbra, Coimbra, Portugal.
  • Cristiana Marques Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal.
  • Dulce Diogo Adult Liver Transplantation Unit, Surgery Department, Coimbra Hospital and Universitary Center, Coimbra, Portugal.

DOI:

https://doi.org/10.53855/bjt.v24i3.417

Keywords:

Liver transplantation, COVID-19, Postoperative Complications

Abstract

Introduction: Since the beginning of corona virus infectious disease (COVID-19) pandemic and the fact that liver transplantation (LT) recipients are immunosuppressed population, a discussion was started about the higher risk for contracting the disease: there was controversy of risk factors for the disease severity and mortality as to the baselineimmunosuppression (IS) regimen and target therapy for COVID-19 management. Purpose: The present work intends to analyze publications (clinical cases and series) to conclude on demographic risk factors, baseline and management of the IS specific COVID-19 therapy and outcome in these patients. Materials and Methods: A research on MEDLINE and PubMed databases was conducted. A total of 127 articles were identified, and 55 included for the final quantitative analysis. Statistical analysis was conducted by using the chi-square test, spearman correlation, and logistic regression. Descriptive analysis were presented in number, percentage or mean and range. Results: A total of 111 single cases were analyzed (95 adults and 16 pediatric). Regarding the adult population, 66 (69.47%) were male and the mean age was 58,73 years. The most common comorbidities were obesity/overweight (35.79%), arterial hypertension (33.68%), and diabetes (27.37%). The most used immunosuppressant was tacrolimus (74.74%) and mycophenolate mofetil (45.26%). Forty-one patients (43.16%) presented complications during treatment and 12 (12.63%) required invasive ventilation. The mortality rate in the adult population was 20%. Regarding the pediatric population, seven (43.75%) were male and the mean age was 1.28 years. The most used immunosuppressant was tacrolimus (93.75%). Only four patients (25%) presented complications, and three (18.75%) required invasive ventilation. Mortality among the pediatric population was 18.75%. Discussion: Justifications were presented based on the literature for the main statistically significant associations. Whenever possible, comparisons were made with other works. Special emphasis was given to comorbidities and immunosuppression. Conclusion: Older age, diabetes, higher white blood cells and support ventilation were associated with worse outcome. Lymphopenia and higher C-reactive protein levels were associated with a severe course of the disease. Mycophenolate mofetil as a baseline immunosuppression regimen was associated with shock during hospital stay. Overall, the mortality rate was higher in LT recipients than in the general population.

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Published

2021-10-18 — Updated on 2021-10-19

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How to Cite

Carmo, A., Marques, C., & Diogo, D. (2021). Covid-19 impact on liver transplantation recipients. Brazilian Journal of Transplantation, 24(3), 6–22. https://doi.org/10.53855/bjt.v24i3.417 (Original work published October 18, 2021)

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Original Paper