Varied clinical presentation and outcome of SARS-CoV-2 infection in liver transplant recipients: Initial experience at a single center in Madrid, Spain

Abstract

Background: Which are the consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in liver transplant (LT) recipients?

Methods: We attempted to address this question by reviewing our single-center experience during the first 2 months of the pandemics at a high incidence area.

Results: Nineteen adult patients (5 females) were diagnosed by May 5, 2020. Median age was 58 (range 55-72), and median follow-up since transplantation was 83 (range 20-183) months. Cough (84.2%), fever (57.9%), and dyspnea (47.4%) were the most common symptoms. Thirteen patients (68.4%) had pneumonia in x-ray/CT scan. Hydroxychloroquine was administered in 11 patients, associated with lopinavir/ritonavir and interferon β in 2 cases each. Immunomodulatory therapy with tocilizumab was used in 2 patients. Immunosuppression (IS) was halted in one patient and modified in only other two due to potential drug interactions. Five (26.3%) patients were managed as outpatient. Two patients (10.5%) died, 10 (52.6%) were discharged home, and 2 (10.5%) were still hospitalized after a median follow-up of 41 days from the onset of symptoms. Baseline IS regimen remained unchanged in all surviving recipients, with good liver function.

Conclusions: Our preliminary experience shows a broad spectrum of disease severity in LT patients with COVID-19, with a favorable outcome in most of them without needing to modify baseline IS.

Keywords: COVID-19; SARS-CoV2; immunosuppression; liver transplant; prognosis.

FIGURE 1

Chest x‐ray of patient ♯9. Left, day of admission. Parenchymal opacity in apical segment of lower left lung. Center, 5 d later, marked radiologic worsening with patchy consolidations peripherally distributed in middle and lower pulmonary fields. Right, a week from the previous study: worsening radiologic pattern with bilateral and peripheral consolidations compatible with severe involvement by COVID‐19. Due to the increase of acute phase reactants (APR), he received tocilizumab on the 6th day of admission, with improvement, being discharged 3 d after the x‐ray on the right

FIGURE 2

Chest CT scan from patient 7. Multiple ground glass infiltrates, predominantly peripheral, in both lungs, highly suspicious of COVID‐19