Impact of COVID-19 on liver transplant recipients–A systematic review and meta-analysis. (August 2021)

• Record Type: Journal Article
• Authors: Kulkarni, Anand V.; Tevethia, Harsh Vardhan; Premkumar, Madhumita; Arab, Juan Pablo; Candia, Roberto; Kumar, Karan; Kumar, Pramod; Sharma, Mithun; Rao, Padaki Nagaraja; Reddy, Duvvuru Nageshwar
• Is Part Of: EClinicalMedicine. Volume 38(2021)
• Publication Date: 2021-08
• Subjects: COVID-19 -- liver transplantation -- liver transplant recipients -- solid organ transplantation -- SARS-CoV-2; Medicine -- Research -- Periodicals; Medical policy -- Periodicals; Clinical Medicine; Health Policy; Public Health; Medical policy; Medicine -- Research; Periodical; Electronic journals; Periodicals; 613
• DOI: 10.1016/j.eclinm.2021.101025
• Languages: English
• ISSNs: 2589-5370

Abstract

Abstract: Background: Immunosuppression and comorbidities increase the risk of severe coronavirus disease-2019 (COVID-19) in solid organ transplant (SOT) recipients. The outcomes of COVID-19 in liver transplant (LT) recipients remain unclear. We aimed to analyse the outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in LT recipients. Methods: The electronic databases were searched for articles published from 1 December 2019 to 20 May 2021 with MeSH terms COVID-19, SARS-CoV-2, and liver transplantation. Studies reporting outcomes in more than 10 LT recipients were included for analysis. LT vs non-LT patients with COVID-19 infection were compared for all-cause mortality, which was the primary outcome studied. We also evaluated the relation between the timing of COVID-19 infection post-LT (< one year vs > one year) and mortality. Findings: Eighteen articles reporting 1, 522 COVID-19 infected LT recipients were included for the systematic review. The mean age (standard deviation [SD]) was 60·38 (5·24) years, and 68·5% were men. The mean time (SD) to COVID-19 infection was 5·72 (1·75) years. Based on 17 studies (I 2 = 7·34) among 1, 481 LT recipients, the cumulative incidence of mortality was 17·4% (95% confidence interval [CI], 15·4–19·6). Mortality was comparable between LT ( n = 610) and non-LT ( n = 239, 704) patients, based on four studies (odds ratio [OR], 0·8 [0·6–1·08]; P = 0·14). Additionally, there was no significant difference in mortality between those infected within one year vs after one year of LT (OR, 1·5 [0·63–3·56]; P = 0·35). The cumulative incidence of graft dysfunction was 2·3% (1·3–4·1). Nearly 23% (20·71–25) of the LT patients developed severe COVID-19 infection. Before infection, 71% and 49% of patients were on tacrolimus and mycophenolate mofetil, respectively. Immunosuppression was modified in 55·9% (38·1–72·2) patients after COVID-19 infection. Interpretation: LT and non-LT patients with COVID-19 have a similar risk of adverse outcomes. Funding: None.