RT Journal Article
T1 Epidemiological pattern, incidence, and outcomes of COVID-19 in liver transplant patients.
A1 Colmenero, Jordi
A1 Rodriguez-Peralvarez, Manuel
A1 Salcedo, Magdalena
A1 Arias-Milla, Ana
A1 Muñoz-Serrano, Alejandro
A1 Graus, Javier
A1 Nuño, Javier
A1 Gastaca, Mikel
A1 Bustamante-Schneider, Javier
A1 Cachero, Alba
A1 Llado, Laura
A1 Caballero, Aranzazu
A1 Fernandez-Yunquera, Ainhoa
A1 Loinaz, Carmelo
A1 Fernandez, Inmaculada
A1 Fondevila, Constantino
A1 Navasa, Miquel
A1 Iñarrairaegui, Mercedes
A1 Castells, Lluis
A1 Pascual, Sonia
A1 Ramírez, Pablo
A1 Vinaixa, Carmen
A1 Gonzalez-Dieguez, Maria Luisa
A1 Gonzalez-Grande, Rocio
A1 Hierro, Loreto
A1 Nogueras, Flor
A1 Otero, Alejandra
A1 Alamo, Jose Maria
A1 Blanco-Fernandez, Gerardo
A1 Fabrega, Emilio
A1 Garcia-Pajares, Fernando
A1 Montero, Jose Luis
A1 Tome, Santiago
A1 De la Rosa, Gloria
A1 Pons, Jose Antonio
K1 COVID-19
K1 Calcineurin inhibitors
K1 Epidemiology
K1 Everolimus
K1 Immunosuppression
K1 Mycophenolate
K1 Pneumonia
K1 SARS-CoV-2
K1 Standardised incidence
K1 Standardised mortality
K1 Tacrolimus
K1 Transplantation
AB The incidence and outcomes of coronavirus disease 2019 (COVID-19) in immunocompromised patients are a matter of debate. We performed a prospective nationwide study including a consecutive cohort of liver transplant patients with COVID-19 recruited during the Spanish outbreak from 28 February to 7 April, 2020. The primary outcome was severe COVID-19, defined as the need for mechanical ventilation, intensive care, and/or death. Age- and gender-standardised incidence and mortality ratios (SIR and SMR) were calculated using data from the Ministry of Health and the Spanish liver transplant registry. Independent predictors of severe COVID-19 among hospitalised patients were analysed using multivariate Cox regression. A total of 111 liver transplant patients were diagnosed with COVID-19 (SIR = 191.2 [95% CI 190.3-192.2]). The epidemiological curve and geographic distribution overlapped widely between the liver transplant and general populations. After a median follow-up of 23 days, 96 patients (86.5%) were admitted to hospital and 22 patients (19.8%) required respiratory support. A total of 12 patients were admitted to the ICU (10.8%). The mortality rate was 18%, which was lower than in the matched general population (SMR = 95.5 [95% CI 94.2-96.8]). Overall, 35 patients (31.5%) met criteria of severe COVID-19. Baseline immunosuppression containing mycophenolate was an independent predictor of severe COVID-19 (relative risk = 3.94; 95% CI 1.59-9.74; p = 0.003), particularly at doses higher than 1,000 mg/day (p = 0.003). This deleterious effect was not observed with calcineurin inhibitors or everolimus and complete immunosuppression withdrawal showed no benefit. Being chronically immunosuppressed, liver transplant patients have an increased risk of acquiring COVID-19 but their mortality rates are lower than the matched general population. Upon hospital admission, mycophenolate dose reduction or withdrawal could help in preventing severe COVID-19. However, complete immunosuppression withdrawal should be discouraged. In liver transplant patients, chronic immunosuppression increases the risk of acquiring COVID-19 but it could reduce disease severity. Complete immunosuppression withdrawal may not be justified. However, mycophenolate withdrawal or temporary conversion to calcineurin inhibitors or everolimus until disease resolution could be beneficial in hospitalised patients.
PB Elsevier
YR 2020
FD 2020-07-27
LK http://hdl.handle.net/10668/16046
UL http://hdl.handle.net/10668/16046
LA en
NO Colmenero J, Rodríguez-Perálvarez M, Salcedo M, Arias-Milla A, Muñoz-Serrano A, Graus J, et al. Epidemiological pattern, incidence, and outcomes of COVID-19 in liver transplant patients. J Hepatol. 2021 Jan;74(1):148-155
DS RISalud
RD May 24, 2025