Covid-19 impact on liver transplantation recipients

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.