COVID-19 Outcomes Explored for Liver Transplant Patients

September 2, 2020

There was no differences found between liver transplant patients and a control group on the proportion of hospitalized patients and patients who required intensive care.

It is currently unclear what the true risk of adverse outcomes is from the coronavirus disease 2019 (COVID-19) for liver transplant recipients.

A team, led by Gwilym J. Webb, PhD, Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, University of Oxford, assessed the clinical outcomes regarding viral outcomes in patients with liver transplants.

In the multicenter cohort study, the investigators gathered data on adult patients with laboratory-confirmed SARS-CoV-2 infections, who had previously received a liver transplant. Each patient had clinician submitted data to 1 of 2 international registries—COVID-Hep or SECURE-Cirrhosis—at the conclusion of the patient’s disease course.

The team excluded patients without a known hospitalization status or mortality outcome.

The researchers also collected data from a contemporaneous cohort of consecutive patients with SARS-CoV-2 infection who had not received a liver transplant from the electronic patient records of the Oxford University Hospitals National Health Service Foundation Trust for comparison.

They compared the cohorts with regard to several outcomes including death, hospitalization, intensive care unit admission, requirement for intensive care, and the need for invasive ventilation and used a propensity score-matched analysis to test for an association between liver transplant and death.

Between March 25 and June 26, they collected data from 151 adult liver transplant recipients from 18 countries, as well as 627 patients who had not undergone liver transplantation. The median age was 60 years old and 68% (n = 102) of the patient population was male for the group that had received liver transplants.

For the control group, the median age was 73 years old and 48% (n = 298) of the patients were female.

The 2 groups did not differ with regard to the proportion of patients hospitalized (124 [82%] patients in the liver transplant cohort vs 474 [76%] in the comparison cohort, P = 0.106). There was also no difference between the 2 groups in patients who required intensive care (47 [31%] vs 185 [30%], P = 0.837).

On the other hand, ICU admission (43 [28%] vs 52 [8%], P <0.0001) and invasive ventilation (30 [20%] vs 32 [5%], P <0.0001) were more frequent in the liver transplant cohort than the control group.

In addition, 28 (19%) patients in the liver transplant cohort died, while 167 (27%) of the patients in the comparison cohort died (P = 0.046).

After adjusting for age, sex, creatinine concentration, obesity, hypertension, diabetes, and ethnicity, the investigators found in the propensity score-matched analysis that liver transplantation did not significantly increase the risk of death in patients with SARS-CoV-2 infection (absolute risk difference, 1.4%; 95% CI, −7.7 to 10.4).

Using the multi-variable logistic regression analysis, the researchers found age (OR, 1.06; 95% CI, 1.01-1.11 per 1 year increase), serum creatinine concentration (OR, 1.57; 95% CI, 1.05-2.36 per 1 mg/dl increase), and non-liver cancer (OR, 18.30; 95% CI, 1.96-170.75) were linked to death among liver transplant recipients.

“Liver transplantation was not independently associated with death, whereas increased age and presence of comorbidities were,” the authors wrote. “Factors other than transplantation should be preferentially considered in relation to physical distancing and provision of medical care for patients with liver transplants during the COVID-19 pandemic.”

The study, “Outcomes following SARS-CoV-2 infection in liver transplant recipients: an international registry study,” was published online in The Lancet Gastroenterology & Hepatology.