Mortality increases among transplantation recipients with COVID-19
Liver transplant candidates with decompensated cirrhosis who were infected with COVID-19 had increased mortality during the first and second waves of the pandemic, according to data published in Gut.
“Increased mortality in [liver transplantation (LT)] candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of [15 or greater] was observed with no significant difference between first and second waves of the pandemic,” Luca Saverio Belli, from the department of hepatology and gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy, and colleagues wrote. “Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventive measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%).”
Belli and colleagues collected data from adult liver transplantation recipients with COVID-19 from February 21 to November 20, 2020. Investigators identified 136 adult cases of laboratory-confirmed SARS-CoV-2 infection from 33 centers in 11 European countries; 113 of these adults had COVID-19.
After a median 18 days, 37 patients died and respiratory failure was the most common cause (89.2%). Belli and colleagues noted the 60-day mortality risk was not significantly altered between first (35.3%; 95% CI, 23.9% to 50%) and second (26%; 95% CI, 16.2% to 40.2%) waves. Clinical presentation and course also were not significantly changed between the two waves of the COVID-19 pandemic.
Multivariable cox regression analysis revealed two important negative independent factors for mortality. The first was a Lab-MELD of 15 or greater (MELD score 15-19 HR = 5.46; 95% CI, 1.18-16.5; MELD score 20 HR = 5.24; 95% CI, 1.77-15.55). The other was dyspnea on presentation (HR = 3.89; 95% CI, 2.02-7.51).
According to researchers, after a median time of 78.5 days, 26 patients underwent a liver transplantation. Twenty-five patients were alive after a median follow-up of 118 days, Belli and colleagues reported. After liver transplantation, short-term survival was 96%. There were no cases of SARS-CoV-2 reinfection reported.