Successful implementation of preventive measures leads to low relevance of SARS-CoV-2 in liver transplant patients: Observations from a German outpatient department

Abstract

Background: Immunosuppressed liver transplant (LT) patients are considered to be at high risk for any kind of infection. What the outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) means for the transplant cohort is a question that, as of now, cannot easily be answered. Data on prevalence, relevance of the novel virus, and clinical course of the infection in stable LT patients are limited.

Methods: Nasopharyngeal swabs were performed in our outpatient department during the shutdown between March and April 2020 in Germany.

Results: The prevalence of SARS-CoV-2 was 3%. Three out of a cohort of 101 LT patients were asymptomatic for respiratory diseases. Respiratory complaints were common and not associated with SARS-CoV-2 infection. The overall monthly mortality rate was 0.22% and did not show alterations during the shutdown in Germany.

Conclusions: If preventive measures are applied, LT patients do not seem to be at a higher risk for SARS-CoV-2 infection. Telemedicine in the outpatient setting may help to maintain distance and to reduce direct patient contact. However, standard of care must be guaranteed for patients with relevant comorbidities in spite of pandemics, because complications may arise from preexisting conditions.

Keywords: clinical research; epidemiology; liver transplantation; sars-cov-2.

Figure 1

Established workflow in the LT outpatient clinic during the pandemic. Procedures for outpatients were established to ensure adequate hygienic prophylaxis with regard to the SARS‐CoV‐2 pandemic. Additional medical staff was recruited to facilitate these procedures, and patients were instructed to maintain strict measures

Figure 2

Pneumonia‐associated mortality 2019 including first 4 mo of 2020. Comparing the incidence of fatal pneumonia with other causes of death in LT patients, data showed an almost homogenous rate. No COVID‐19‐associated pneumonia was observed

Figure 3

Symptoms or laboratory abnormalities at time of nasopharyngeal swab. In n = 101 patients, a nasopharyngeal swab was performed for detection of SARS‐CoV‐2 infection. Only n = 3 tested to be positive, and all were asymptomatic. Patients with respiratory symptoms either showed only mild symptoms or suffered from community aquired pneumonia. In cases with deterioration of liver function, no association of SARS‐CoV‐2 infection was found

Figure 4

Post‐transplant mortality for 2019 including first 4 mo of 2020.Mortality of liver transplant patients was analyzed for cause of death. No increase in mortality in the first 4 mo of 2020 was noted