Covid-19 in liver transplant recipients: the French SOT COVID registry

Abstract

Background: Notwithstanding the ongoing coronavirus disease-2019 (Covid-19) pandemic, information on its clinical presentation and prognosis in organ transplant recipients remains limited. The aim of this registry-based observational study was to report the characteristics and clinical outcomes of liver transplant (LT) recipients included in the French nationwide Registry of Solid Organ Transplant Recipients with Covid-19.

Methods: COVID-19 was diagnosed in patients who had a positive PCR assay for SARS-CoV-2 or in presence of typical lung lesions on imaging or specific SARS-CoV-2 antibodies. Clinical and laboratory characteristics, management of immunosuppression, treatment for Covid-19, and clinical outcomes (hospitalization, admission to intensive care unit, mechanical ventilation, or death) were recorded.

Results: Of the 104 patients, 67 were admitted to hospital and 37 were managed at home (including all 13 children). Hospitalized patients had a median age of 65.2 years (IQR: 58.1 - 73.2 years) and two thirds were men. Most common comorbidities included overweight (67.3%), hypertension (61.2%), diabetes (50.7%), cardiovascular disease (20.9%) and respiratory disease (16.4%). SARS-CoV-2 infection was identified after a median of 92.8 months (IQR: 40.1 - 194.7 months) from LT. During hospitalization, antimetabolites, mTOR inhibitor, and CNIs were withdrawn in 41.9%, 30.0% and 12.5% of patients, respectively. The composite endpoint of severe Covid-19 within 30 days after diagnosis was reached by 33.0% of the adult patients. The 30-day mortality rate was 20.0%, and 28.1% for hospitalized patients. Multivariate analysis identified that age was independently associated with mortality.

Conclusion: In our large nationwide study, Covid-19 in LT recipients was associated with a high mortality rate.

Keywords: Covid-19; Immunosuppression; Liver transplantation; Mortality; Prognosis.

Figure 1

Outcome of 91 adult LT recipients with Covid-19. A. Probability of reaching the composite endpoint of severe disease (ICU admission or mechanical ventilation or death) in LT adult recipients with Covid-19. The cumulative incidence for the composite endpoint at day-30 was 33.0% (22.6–42.0). B. Probability of reaching the composite endpoint of severe disease (ICU admission or mechanical ventilation or death) in LT adult recipients who were hospitalized with Covid-19. The cumulative incidence for the composite endpoint at day-30 was 44.8% (31.5–55.5). C. Kaplan–Meier plot of survival in adult LT recipients with Covid-19. The 30-day survival rate after diagnosis was 80.0% (71.8–89.0). D. Kaplan–Meier plot of survival in adult LT recipients who were hospitalized with Covid-19. The 30-day survival rate after diagnosis was 71.9% (61.3–84.3).