COVID-19 in liver transplant candidates: pretransplant and post-transplant outcomes - an ELITA/ELTR multicentre cohort study. Issue 10 (19th July 2021)

• Record Type: Journal Article
• Authors: Belli, Luca Saverio; Duvoux, Christophe; Cortesi, Paolo Angelo; Facchetti, Rita; Iacob, Speranta; Perricone, Giovanni; Radenne, Sylvie; Conti, Sara; Patrono, Damiano; Berlakovich, Gabriela; Hann, Angus; Pasulo, Luisa; Castells, Lluis; Faitot, Francois; Detry, Olivier; Invernizzi, Federica; Magini, Giulia; De Simone, Paolo; Kounis, Ilias; Morelli, Maria Cristina; Díaz Fontenla, Fernando; Ericzon, Bo-Göran; Loinaz, Carmelo; Johnston, Chris; Gheorghe, Liliana; Lesurtel, Mickael; Romagnoli, Renato; Kollmann, Dagmar; Perera, M Thamara PR; Fagiuoli, Stefano; Mirza, Darius; Coilly, Audrey; Toso, Christian; Zieniewicz, Krzysztof; Elkrief, Laure; Karam, Vincent; Adam, Rene; den Hoed, Caroline; Merli, Marco; Puoti, Massimo; De Carlis, Luciano; Oniscu, Gabriel C; Piano, Salvatore; Angeli, Paolo; Fondevila, Constantino; Polak, Wojciech G;
• Other Names: author non-byline.; Viganò Raffaella author non-byline.; Mazzarelli Chiara author non-byline.; Lauterio Andrea author non-byline.; Giacomoni Alessandro author non-byline.; Travi Giovanna author non-byline.; Puoti Massimo author non-byline.; Donato Francesca author non-byline.; Lampertico Pietro author non-byline.; Colledan Michele author non-byline.; Zambelli Marco author non-byline.; Guizzetti Michela author non-byline.; Vitale Giovanni author non-byline.; Benedetto Fabrizio Di author non-byline.; Carrai Paola author non-byline.; Petruccelli Stefania author non-byline.; Incicco Simone author non-byline.; Zen Nicola author non-byline.; Michard Baptiste author non-byline.; Faouzi Saliba author non-byline.; Samiuel Didier author non-byline.; Ngongang Norbert author non-byline.; Poinsot Domitille author non-byline.; Guichon Celine author non-byline.; Gonzales Emmanuel author non-byline.; Manaz Derek author non-byline.; Colmenero Jordi author non-byline.; Toapanta David author non-byline.; Hidalgo Ernest author non-byline.; Alamo Jose Maria author non-byline.; Gomes Esther Brea author non-byline.; Blanco Gerardo author non-byline.; Marcacuzco Alberto author non-byline.; Rodriguez Gonzalo author non-byline.; Pascual Sonia author non-byline.; Györi Georg author non-byline.; Pirenne JAcques author non-byline.; Vandende Natalie author non-byline.; Lucidi Valerio author non-byline.; Magini Giulia author non-byline.; Goossens Nicolas author non-byline.; Jorns Carl author non-byline.; Popescu Irinel author non-byline.; Raszeja-Wyszomirska Joanna author non-byline.;
• Is Part Of: Gut. Volume 70:Issue 10(2021)
• Page Start: 1914
• Page End: 1924
• Publication Date: 2021-07-19
• Subjects: liver cirrhosis -- liver transplantation -- COVID-19; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2021-324879
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Objective: Explore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course. Design: Data from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and were analysed. Results: From 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32.7%) patients died after a median of 18 (10–30) days, with respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not significantly change between first (35.3%, 95% CI 23.9% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15–19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44–102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31–170). Conclusions: Increased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventative 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%).