COVID-19; liver cirrhosis; liver transplantation; organ transplantation; transplantation; liege
Abstract :
[en] OBJECTIVE: Explore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course. DESIGN: Data from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and were analysed. RESULTS: From 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32.7%) patients died after a median of 18 (10-30) days, with respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not significantly change between first (35.3%, 95% CI 23.9% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15-19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44-102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31-170). CONCLUSIONS: Increased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventative measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%).
Disciplines :
Gastroenterology & hepatology Surgery
Author, co-author :
Belli, Luca Saverio
Duvoux, Christophe
Cortesi, Paolo Angelo
Facchetti, Rita
Iacob, Speranta
Perricone, Giovanni
Radenne, Sylvie
Conti, Sara
Patrono, Damiano
Berlakovich, Gabriela
Hann, Angus
Pasulo, Luisa
Castells, Lluis
Faitot, Francois
Detry, Olivier ; Université de Liège - ULiège > Département des sciences cliniques > Pathologie chirurgicale abdominale et endocrinienne
Foreman MG, Mannino DM, Moss M. Cirrhosis as a risk factor for sepsis and death: analysis of the National hospital discharge survey. Chest 2003;124:1016-20.
Jalan R, Fernandez J, Wiest R, et al. Bacterial infections in cirrhosis: a position statement based on the EASL special conference 2013. J Hepatol 2014;60:1310-24.
Piano S, Singh V, Caraceni P, et al. Epidemiology and effects of bacterial infections in patients with cirrhosis worldwide. Gastroenterology 2019;156:e1310:1368-80.
Albillos A, Lario M, Alvarez-Mon M. Cirrhosis-associated immune dysfunction: distinctive features and clinical relevance. J Hepatol 2014;61:1385-96.
Moreau R, Jalan R, Gines P, et al. Acute-On-Chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013;144:1426-37. 1437 e1421-1429.
Fernandez J, Acevedo J, Wiest R, et al. Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis. Gut 2018;67:1870-80.
Premkumar M, Devurgowda D, Dudha S, et al. A/H1N1/09 influenza is associated with high mortality in liver cirrhosis. J Clin Exp Hepatol 2019;9:162-70.
Jalan R, Saliba F, Pavesi M, et al. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. J Hepatol 2014;61:1038-47.
Gray RJ. A Class of $K$-Sample Tests for Comparing the Cumulative Incidence of a Competing Risk. Ann Stat 1988;16:1141-54.
Freeman RB, Wiesner RH, Roberts JP, et al. Improving liver allocation: MELD and PelD. Am J Transplant 2004;4 Suppl 9:114-31.
Bajaj JS, Garcia-Tsao G, Biggins SW, et al. Comparison of mortality risk in patients with cirrhosis and COVID-19 compared with patients with cirrhosis alone and COVID-19 alone: multicentre matched cohort. Gut 2021;70:531-6.
Hashemi N, Viveiros K, Redd WD, et al. Impact of chronic liver disease on outcomes of hospitalized patients with COVID-19: a multicentre United States experience. Liver Int 2020;40:2515-21.
Singh S, Khan A. Clinical characteristics and outcomes of coronavirus disease 2019 among patients with preexisting liver disease in the United States: a multicenter research network study. Gastroenterology 2020;159:768-71.
Qi X, Liu Y, Wang J, et al. Clinical course and risk factors for mortality of COVID-19 patients with pre-existing cirrhosis: a multicentre cohort study. Gut 2021;70:gutjnl-2020-321666.
Marjot T, Moon AM, Cook JA, et al. Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: an international registry study. J Hepatol 2021;74:33667-9.
Iavarone M, D'Ambrosio R, Soria A, et al. High rates of 30-day mortality in patients with cirrhosis and COVID-19. J Hepatol 2020;73:1063-71.
Horby P, Lim WS, Emberson JR. Dexamethasone in Hospitalized Patients with Covid-19-Preliminary Report. NEJM 2020.
Beigel JH, Tomashek KM, Dodd LE. Remdesivir for the Treatment of Covid-19-Preliminary Report. NEJM 2020 https:// doi. org/ 10. 1056/ NEJMo a2007 764
Rana A, Witte ED, Halazun KJ, et al. Liver transplant length of stay (Los) index: a novel predictive score for hospital length of stay following liver transplantation. Clin Transplant 2017;31:e13141.
