COVID-19 in liver transplant candidates: wait-list outcomes and post-transplant course

Background: The impact of prior SARS-CoV-2 infection on patients on the
waiting list for liver transplantation (LT) and on their post-LT course is presently
unknown.
Methods: Data from adult LT candidates with laboratory confirmed SARSCoV-
2 infection was collected across Europe and all consecutive patients
with symptomatic COVID-19 were included in the analysis.
Results: From February 21st to November 20th, 2020, 136 adult cases with
laboratory-confirmed SARS-CoV-2 infection from 33 centers in 10 European
countries were collected, with 113 having symptomatic COVID-19. Thirtythree
(29.2%) were managed as outpatients, 80 (70.8%) required hospitalization
including admission to the intensive care unit (28/80, 35%). Thirtyseven
(37/113, 32.7%) patients died after a median of 18 (10-30) days, respiratory
failure being the major cause (33/37, 89.2%). The 60-day mortality
risk did not change between first (35.3%, 95% CI 23.9-50.0) and second
wave (26.0%, 95% CI 16.2-40.2). Multivariable Cox regression analysis
showed MELD score !15 (MELD15-19:HR 6.09 95%CI 2.01-18.44;
MELD ! 20:HR 5.21, 95%CI 1.76-15.45) and dyspnea on presentation
(HR:4.1, 95%CI 2.09-8.06) being the two negative independent factors for
mortality. Twenty-six patient received a LT after a median time of 78.5
(IQR:44-102) days and 25 are alive after a median follow-up of 118 days
(IQR:31-170).
Conclusions: Mortality of LT candidates with symptomatic COVID-19 was
high (32.7%) peaking at 45% in decompensated cirrhotic with MELD > 15
and did not significantly differ between the 2 waves of the pandemic, respiratory
failure being the major cause of death thus supporting high priority
for vaccination. Prior SARS-CoV-2 infection did not affect early post-transplant
survival (96%).
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