COVID-19 infection in liver transplant recipients: results from a Brazillian multicentric historical cohort
Ilka FSF Boin1, Eduardo Riccetto1, Tercio Genzini2, Lucio FP Moreira3, Raquel SB Stucchi1, Renato F Silva4, Luciana Haddad5, Marcio D Almeida6, Andre Watanabe7, Gustavo S Peixoto8, Claudio ML Melo9, Nertan L Teffili10, Marcia Halpern11, Maira C Godoy12, Jorge MP Mancero13, Jose Huygens P Garcia14, Elaine C Ataide1.
1Unit of Liver Transplantation, State Univeristy of Campinas, Campinas, Brazil; 2Liver transplantation unit, Clinics Hospital FUNDHACRE / Leforte Hospital, Rio Branco, Brazil; 3Unit of Liver Transplantation, IDOR – Teaching and research institute, Rio de Janeiro, Brazil; 4Unit of Liver Transplantation, Sao Jose do Rio Preto Medical School University Hospital, Sao Jose do Rio Preto, Brazil; 5Unit of Liver Transplantation, University of Sao Paulo Medical School - Clinics Hospital, São Paulo, Brazil; 6Unit of Liver Transplantation, Albert Einstein Israeli Hospital, Sao Paulo, São Paulo, Brazil; 7Unit of Liver Transplantation, Federal Distric Cardiology Institute, Brasilia, Brazil; 8Unit of Liver Transplantation, Meridional Hospital, Vitoria, Brazil; 9Unit of Liver Transplantation, Professor Fernando Figueira Integral Medicine Institute, Recife, Brazil; 10Unit of Liver Transplantation, Sao Vicente Hospital, Curitiba, Curitiba, Brazil; 11Unit of Liver Transplantation, Federal University of Rio de Janeiro – University Hospital, Rio de Janeiro, Brazil; 12Unit of Liver Transplantation, Santa Isabel Hospital, Blumenau, Brazil; 13Unit of Liver Transplantation, Portuguese Beneficiency Hospital, São Paulo, Brazil; 14Unit of Liver Transplantation, Federal University of Ceara – Walter Cantido University Hospital, Fortaleza, Brazil
COVID-19 Brazilian Transplantation Study Group.
Introduction: Amid the COVID-19 pandemic, the consequences of infection by the SARS-CoV 2 virus in Liver Transplant recipients (LT) patients is of particular concern, notably due to the perceived added risk of these patients related to immunosuppression and comorbidity burden. Current literature on this topic often uses small, non-standardized, and ethnically limited samples. This study describes COVID-19 presentation and complications in a large, multicentric, and ethnically diverse population of LT recipients.
Methods: We designed this study as a multi-centric historical cohort, analyzing patient records submitted by an online questionnaire. The study included LT recipient patients with suspected or confirmed COVID-19 already in follow-up at the study centers. The primary endpoint was COVID-related death. We also collected demographic, clinical, and laboratory data regarding presentation and disease progression.
Results: We included 314 patients from 25 participant centers in Brazil. It is, to our knowledge, the largest current cohort of LT recipients with COVID-19. The median age was 60 years old (IQR: 53-66), and the hospitalization rate was 56%, with an overall mortality rate of 17,9%. Patients were mostly male (66%), white (59%), and overweight, with a median BMI of 27 (IQR 24-32). The median follow-up time was 117 days (IQR 41,291). The two most prevalent comorbidities were hypertension (N= 138 - 48%) and diabetes (N= 129 - 45%). Increased mortality was associated with fewer years from transplantation (p=0.03), increased BMI (p=0.02), the presence of dyspnea (p<0.001), and lost sense of smell (p=0.01) at presentation, and alterations to immunosuppression after admission (p<0.001). The use of mycophenolate at admission was also associated with increased mortality (p=0.02). Liver function test results were not associated with mortality. Median time from admission to death was 22 days (IQR: 12-35).
Conclusion: This large, multicentric study suggests novel risk factors for mortality not previously reported in other studies - notably the use of Mycophenolate and fewer years from transplantation. As such, the results of this study are paramount to the comprehensive and individualized treatment of this multifaceted patient population and stand as a stepping stone for further understanding of the disease presentation in these patients.
Regina G Santos, Laura CM Pinto, Simone R Peralles, Leticia Zanaga, Rita CMF Silva, Luiz AC Dalbuquerque, Renata Ferreira Bezerra, Marcelo Nogara, Huda M Noujam, Agnaldo S Lima, Ana F Passos, Ivelise RC Brasil, Renato Hidalgo, Christian E Garcia, Ajith K Sankarankutty, Adriano M Gonzales, Andre I David, Mauricio Barros, Ben-Hur E Ferraz-Neto, Claudemiro Quireze-Júnior, Eduardo Fonseca.
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