The Covid-19 epidemiological profile of disease presented two main waves in the world as well as in Brazil between 2020 and 2021.There are no robust works describing the profile of liver transplant patients who are victims of COVID-19, especially when it comes to comparing this profile against the waves. We carried out a national multicenter study that can cover a significant number of liver transplant patients and verify the prognostic factors of survival of these patients according to the period of illness by COVID-19.
The main objective of this study was to evaluate factors associated with wave survival in COVID-19 disease, in the postoperative period of liver transplantation.
This is a cross-sectional, retrospective study, with analysis of data from the medical records of patients with suspicion or positivity for COVID-19 provided by the coordinators of the Liver Transplantation Groups of Brazil (GTxF-COVID-19/Brazil), through a survey applied online.
In this study, 25 centers were evaluated, totaling 311 patients in the postoperative period of liver transplantation, of which 128 (41.1%) were treated at home and 183 (58.9%) were hospitalized. Of the 183 hospitalized, 54 (hospital mortality of 29.5%) died. The need for mechanical ventilation was 65/183 (35.5%).
The prevalence in this study was 311/16345 (1.9% or 1,900) and mortality was about 291.2 per 100,000 inhab. (17.36%). There were no records of deaths at home.
Evaluating the number of cases according to the waves of COVID-19, we observed that in wave 1 there were 131 cases (47.3%) and in wave 2 there were 146 cases (52.7%).
In the two waves, the most frequent symptoms (over 10 cases) were: fever, cough, dyspnea, fatigue, coryza, headache, diarrhea, myalgia and dyspnea. The most frequent comorbidities in both waves were diabetes, hypertension, obesity, smoking, kidney disease and heart disease.
The length of stay in ICU days was longer in the first wave (5.72 ± 11.79; p=0.04) than in the second wave. There was a greater number of hospital admissions in the first wave, 70.2% against 53.4% in the second wave (p=0.004). There was a greater number of “pre” COVID-19 treatment (use of hydroxychloroquine, chloroquine and azithromycin) in the first wave (65.6%) compared to the second wave (51.9%) and this difference was significant (p= 0.03).
There was less management, reduction or withdrawal of immunosuppression in these patients in the second wave (p=0.02).
The actuarial survival curve estimated by the Kaplan-Meier method comparing survival from the onset of symptoms to resolution of the patients' clinical condition did not show a statistically significant difference between the two waves.
As already mentioned, there are no reports of cases similar to ours in relation to COVID-19 after liver transplantation, however, studies such as the one presented here are imperative in order to create solid foundations for definitions of the management of this population that requires attention and safe criteria.