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COVID-19 in Liver Transplant Recipients: 2

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COVID-19 in Liver Transplant Recipients: 2 1. Güven Hospital, Dept of Gastroenterology and Liver Transplantation, Ankara, Turkey COVID-19 in Liver Transplant Recipients: 2. Ege University School of Medicine, Dept of Gastroenterology, İzmir, Turkey 3. Uludağ University School of Medicine, Dept of Gastroenterology, Bursa, Turkey A National Cohort 4. Ankara University School of Medicine, Dept of Gastroenterology, Ankara, Turkey 5. Dokuz Eylül University School of Medicine, Dept of Gastroenterology, İzmir, Turkey 6. Medipol University School of Medicine, Dept of Liver Transplantation, İstanbul, Turkey 1 2 3 4 5 6 7 G Kabaçam , İ Turan , M Kıyıcı , Z Melekoğlu Ellik , S Dolu , M Dayangaç , D Arı , D 7. Ankara City Hospital, Dept of Gastroenterology, Ankara, Turkey Turan Gökçe7, E Yıldırım8, G Gençdal9, M Harputluoğlu10, A Kartal11, EK Dindar 8. Gaziantep University School of Medicine, Dept of Gastroenterology, Gaziantep, Turkey Demiray12, F Gündüz13, İ Ergenç13, C Efe14, H Gökçan4, M Akdoğan Kayhan7, MT 9. Koç University School of Medicine, Dept of Gastroenterology, İstanbul, Turkey 10. İnönü University School of Medicine, Dept of Gastroenterology, Malatya, Turkey 8 9 15 16 17 18 5 Gülşen , M Akyıldız , Ç Arıkan , S Karademir , D Balcı , Z Dündar , M Akarsu , F 11. Kütahya Education and Research Hospital, Dept of Gastroenterology, Kütahya, Turkey Günşar2, Z Karasu2, R İdilman4 and the Turkish Association for the Study of the 12. Bitlis State Hospital, Dept of Infectious Diseases, Bitlis, Turkey Liver (TASL), Acute Liver Failure and Liver Transplantation Special Interest Group. 13. Marmara University School of Medicine, Dept of Gastroenterology, İstanbul, Turkey 14. Harran University School of Medicine, Dept of Gastroenterology, Şanlıurfa, Turkey Scan to download the 15. Koç University School of Medicine, Dept of Pediatric Gastroenterology, İstanbul, Turkey poster 16. Güven Hospital, Dept of Liver Transplantation, Ankara, Turkey 17. Ankara University School of Medicine, Dept of Liver Transplantation, Ankara, Turkey 1 4 18. Uludağ University School of Medicine, Dept of General Surgery, Bursa, Turkey Introduction Results The effect of coronavirus disease 2019 (COVID-19) on outcomes of liver transplant A total of 129 liver transplant recipient had diagnosed with COVID-19. Median age was 56 years. The recipients recipients is not known very well. were predominantly male (69%). The median interval between liver transplantation (LT) and COVID-19 diagnosis was 48 months: 18 recipients had been transplanted less than one year, while 49 recipients had been transplanted more than 5 years (Figure 1). The most common etiology of LT was hepatitis B virus related liver disease (45.7%) (Table 2). LT type was predominantly live donor in 56.9% of the cases. Immunosuppressive Aim protocol comprised of single agent in 42% of the patients, double agents in 48%, triple agents in 7% depending on the duration after LT and center policy. The aim of the present study was to describe the early outcomes of liver transplant recipients with COVID-19. At the time of COVID-19 diagnosis, most recipients (54%) had at least one co-morbidity including diabetes mellitus (31.8%), hypertension (36.4%). Main presenting symptom was malaise (78%)(Figure 2). Laboratory findings in presentation can be seen in table 2. Pneumonic infiltration was observed in 64% of the recipients, Methods 22.5% had relevant increase in liver enzymes. • Liver transplant recipients with concomitant confirmed severe acute respiratory syndrome After the diagnosis, 47% of the recipients were treated in the ward, and 12% was taken to the ICU. Main coronavirus 2 (SARS-CoV-2) infection from 14 tertiary liver transplant centers of Turkey modalities of medical treatment were according to the Turkish Ministry of Health Covid Guidance and center were enrolled into the study. preference (Table 3). Among whole cases 14.7% of them needed nasal oxygen therapy, and 10.2% required • The diagnosis of SARS-CoV-2 infection was made according to the World Health intubation and invasive mechanical ventilation. Organization guidelines and based on the presence of clinical features, laboratory and radiological findings. Overall, 12 recipients (9.4%) died due to COVID-19 related respiratory or multisystem failure (Figure 3). With • The immunosuppressive protocol consisted of calcineurin inhibitors (CNIs) plus multivariate analysis, c-reactive protein (CRP), procalcitonin levels and mechanical ventilation requirement were mycophenolate mofetil (MMF) and a steroid. the risk factors that are significantly associated with mortality (Table 4). • Alternative agents, including sirolimus or everolimus were used. Figure 1. Histogram showing the interval Table 1. Underlying etiology of liver disease before Figure 2. Main presenting symptoms of between transplantation and Covid-19 patients • Data were entered in an electronic case report form (CRF) from each center and collected transplantation diagnosis from the CRF. Symptom (%) Malaise Conclusions Fever Cough Limitations of this study: Dyspnea Overestimation due to selection bias Diarrhea A small percentage of Tx centers have shared their data – not represent whole transplant 0 20 40 60 80 100 Symptom (%) population Table 2. Basal laboratory findings of patients. Figure 3. Mortality among the cases Table 4. Analysis of risk factors at initial presentation for Interval between LT and Covid – 19 may have an impact on the course of infection due to, mortality Parameter Mean (SD) Median (Min – Max) prolonged immunosuppression exposure, accumulation of metabolic – related comorbidities. Mortality Parameter Correlation % 95 CI p value coefficient COVID-19 significantly affects the outcome of LT recipients. Increased CRP and procalcitonin AST 39.4 (31.5) 29 (7 – 170) 12 Univariate analysis levels in admission and mechanical ventilation requirement are the most important risk ALT 43.4 (56.6) 28 (7 – 467) AST 0.120 0.118 – 1.110 0.027 factors for mortality. ALP 167.6 (127.9) 119 (41 – 608) Total Bilirubin 0.227 0.104 – 2.100 0.015 GGT 108.6 (119.0) 50 (8 – 768) 117 LDH 0.217 0.166 – 1.522 <.001 References Total Bilirubin 1.35 (2.87) 0.63 (0.1 – 20) CRP 0.242 0.097 – 2.201 0.01 INR 1.13 (0.34) 1.04 (0.5 – 3.16) Procalcitonin 0.339 0.131 – 1.871 0.072 1. Belli LS, et al. Protective Role of Tacrolimus, Deleterious Role of Age and Comorbidities in Liver Transplant Yes No Recipients With Covid-19: Results From the ELITA/ELTR Multi-center European Study. Gastroenterology. Creatinine 1.33 (1.2) 1.04 (0.48 – 9.95) Comorbidity 0.208 0.079 – 2.382 0.019 2021;160(4):1151-63.e3. LDH 276.6 (159.5) 222.0 (135 – 1092) Dyspnea 0.398 0.093 – 4.750 <.001 2. Buscemi V, et al. Does interval time between liver transplant and COVID-19 infection make the difference? Dig CRP 38.6 (51.8) 16.5 (0.6 – 273) Pneumonia at CXR 0.276 0.094 – 2.743 0.007 Liver Dis. 2021;53(2):169-70. 3. Kabaçam G, et al. The COVID-19 pandemic: Clinical practice advice for gastroenterologists, hepatologists, Procalcitonin 0.54 (0.71) 0.1 (0.02 – 2.2) Mechanical 0.660 0.455 – 1.250 <.001 and liver transplant specialists. Turk J Gastroenterol. 2020;31(5):348-55. ventilation 4. Miarons M, et al. COVID-19 in Solid Organ Transplantation: A Matched Retrospective Cohort Study and Table 3. Modality of Covid treatment requirement Evaluation of Immunosuppression Management. Transplantation. 2021;105(1):138-50. Multivariate analysis General hepatology Gkhan Kabaam 5. Patrono D, et al. Outcome of COVID-19 in liver transplant recipients: A preliminary report from Northwestern CRP 0.695 0.450 – 1.340 <.001 Italy. Transpl Infect Dis. 2020;22(5):e13353. Procalcitonin 0.471 0.230 – 1.120 0.004 Mechanical 0.730 0.460 – 1.800 <.001 Contact information ventilation requirement Gökhan Kabaçam: [email protected] PO-2001 ILC2021.
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