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Title: Clinical Presentation, Treatment, and Mortality Rate in Liver Transplant Recipients With Coronavirus Disease 2019: A Systematic Review and Quantitative Analysis.
Austin Authors: Fraser, Jacqueline ;Mousley, Johanna;Testro, Adam G ;Smibert, Olivia C ;Koshy, Anoop N 
Affiliation: Gastroenterology and Hepatology
Victorian Liver Transplant Unit
The University of Melbourne, Parkville, Victoria, Australia
Infectious Diseases
The National Centre for Infections in Cancer, Peter McCallum Cancer Centre, Melbourne, VIC, Australia
Deakin University, School of Medicine, Geelong, Victoria, Australia
Issue Date: Nov-2020
Date: 2020-07-30
Publication information: Transplantation Proceedings 2020; 52(9): 2676-2683
Abstract: Liver transplant recipients may be at increased risk for adverse outcomes with coronavirus disease 2019 (COVID-19) infection because of chronic immunosuppression and associated comorbidities. There is a paucity of literature describing clinical presentation, treatments, and outcomes in liver transplant recipients with COVID-19. A systematic search was performed for articles published up to June 15, 2020, revealing 223 liver transplant recipients with COVID-19 in 15 studies. Patients most commonly presented with fever (66.7%), dyspnea (34.0%), and diarrhea (28.4%). Of these, 77.7% required hospitalization, 24% had mild disease, 40% had moderate disease, and 36% had severe disease. Immunosuppression was modified in 32.8% of recipients. The case fatality rate was 19.3%. Dyspnea on presentation, diabetes mellitus, and age 60 years or older were significantly associated with increased mortality (P ≤ .01) with a trend to higher mortality rate observed in those with hypertension and those receiving corticosteroids at the time of COVID-19 diagnosis. The median time from symptoms to death was 11.5 days (2-45 days). In conclusion, liver transplant recipients with severe acute respiratory syndrome coronavirus 2 are overrepresented with regard to severe disease and hospitalizations. Older liver transplant patients with diabetes mellitus or hypertension, who are on maintenance corticosteroids, with a diagnosis of COVID-19 and describing breathlessness should be aggressively monitored for signs of deterioration because of the risk for mortality.
DOI: 10.1016/j.transproceed.2020.07.012
Journal: Transplantation Proceedings
PubMed URL: 32891405
Type: Journal Article
Subjects: COVID-19
Appears in Collections:Journal articles

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