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. 2020 Oct;33(10):1244-1252.
doi: 10.1111/tri.13680. Epub 2020 Aug 13.

Impact of COVID-19 on liver transplantation in Europe: alert from an early survey of European Liver and Intestine Transplantation Association and European Liver Transplant Registry

Wojciech G Polak  1 , Constantino Fondevila  2 , Vincent Karam  3 , Rene Adam  4 , Ulrich Baumann  5   6 , Giacomo Germani  7 , Silvio Nadalin  8 , Pavel Taimr  9 , Christian Toso  10 , Roberto I Troisi  11 , Krzysztof Zieniewicz  12 , Luca S Belli  13 , Christophe Duvoux  14
Affiliations

Impact of COVID-19 on liver transplantation in Europe: alert from an early survey of European Liver and Intestine Transplantation Association and European Liver Transplant Registry

Wojciech G Polak et al. Transpl Int. 2020 Oct.

Abstract

There are scarce data on the impact of COVID-19 pandemic on liver transplantation (LT) in Europe. The aim of this study was to obtain a preliminary data on incidence, management, and outcome of COVID-19 in liver transplant recipients and candidates in Europe. An Internet-based survey was sent to the centers affiliated with European Liver Transplant Registry (ELTR). One hundred nine out of 149 (73%) of ELTR centers located in 28 European countries (93%) responded. Ninety-four (86%) of the centers tested all donors, and 75 (69%) centers tested all LT recipients for SARS-CoV-2. Seventy-three (67%) centers selected recipients for LT in the COVID-19 pandemic, whereas 33% did not. Eighty-eight centers reported COVID-19 infection in 57 LT candidates and in 272 LT recipients. Overall crude incidence of COVID-19 among LT candidates and recipients was estimated 1.05% (range 0.5-20%) and 0.34% (range 0.1-4.8%), respectively, and it was significantly higher among candidates (P < 0.001). Crude rate of death was 18% (10/57) among candidates and 15% (36/244) among recipients. This first large-scale European snapshot study clearly shows that both LT candidates and recipients are at a high risk for COVID-19. These results plead for an early and pro-active screening of COVID-19 symptoms in these populations.

Keywords: COVID-19; SARS-CoV-2; liver recipient; liver transplantation; mortality; survey.

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Conflict of interest statement

The authors have declared no conflicts of interest.

Figures

Figure 1
Figure 1
Outline of the study.
Figure 2
Figure 2
Management of liver donors in European center during COVID‐19 pandemic. (a) Donor testing with nasopharyngeal swab PCR for SARS‐CoV‐2. (b) Liver transplantation from SARS‐CoV‐2 positive donors. (c) Recipient selection for liver grafts from SARS‐CoV‐2 positive donors. (d) Living liver donors testing for SARS‐CoV‐2. E. Delay time in live liver donation in SARS‐CoV‐2 positive donors.
Figure 3
Figure 3
Management of liver recipients in European center during COVID‐19 pandemic. (a) Potential recipient testing with nasopharyngeal swab PCR for SARS‐CoV‐2. (b) Consequences of SARS‐CoV‐2 positivity in the potential liver recipient. (c) Consequences of unknown SARS‐CoV‐19 status in the potential liver recipient. (d) Selection of liver recipient for transplantation in COVID‐19 pandemic. (e) Management of SARS‐CoV‐2 positive liver recipients.
Figure 4
Figure 4
Number of SARS‐CoV‐2 positive liver transplant recipient and candidates.
Figure 5
Figure 5
Distribution of SARS‐CoV‐2 positive liver transplant candidates and recipient and in Europe.
Figure 6
Figure 6
Incidence of SARS‐CoV‐2 in liver transplant patients compared to the general population.
Figure 7
Figure 7
Intensive care admission among SARS‐CoV‐2 positive liver transplant patients.
Figure 8
Figure 8
Incidence of mortality among SARS‐CoV‐2 positive liver transplant patients compared to the general population.
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