Clinical course of COVID-19 infection in liver transplant patients

Abstract

In the presence of chronic liver diseases, the post‑infectious period of COVID‑19 is difficult and potentially mortal. The impact of COVID‑19 on liver transplant patients has not been thoroughly investigated.
 Objective — to study the characteristics of the clinical course of COVID‑19 in liver transplant patients.
 Materials and methods. At the end of December 2014, the first successful liver transplant operation in Georgia was performed at the Batumi Referral Hospital of the Autonomous Republic of Adjara. To date, a total of surgical interventions have been conducted, including 42 surgeries since the beginning of the pandemic. We analysed
 The incidence of COVID‑19 infection in the cohort of 88 patients throughout their hospital stay after liver transplant and at the late postoperative period was analysed, as well as the characteristics of the clinical course of COVID‑19. To prevent COVID‑19 transmission within the hospital, a special protocol been developed: to ensure that the patient is safely isolated from contact with the source of infection. In the postoperative period, all patients received immunosuppressive therapy. To monitor the course of the disease, an interdisciplinary team was created, which consisted of a transplant surgeon, hepatologist, gastroenterologist, infectious disease specialist, therapist, and immunologist. The consultation was held at the place of residence and treatment of a patient.
 Results. No cases of COVID‑19 infection were reported among patients at the hospital where the liver transplant was conducted. In the late period, COVID‑19 was registered in 17 (19.3%) patients, of whom one (5.9%) died from the infection. One patient was infected with COVID‑19 twice. We have identified four variants of the clinical course of COVID‑19: mild (23.5%) — without any symptoms except for mild respiratory symptoms; aggravated (41.2%) — mild respiratory symptoms and dyspeptic symptoms without significant changes in clinical diagnostic parameters; moderate (29.4%) — cough without sputum, hyperthermia for three days, decreased sense of smell, the presence of dyspeptic symptoms, increased average values of biochemical parameters (alanine aminotransferase, aspartate aminotransferase, γ‑glutamyl transpeptidase, alkaline phosphatase, total bilirubin); severe (5.9%) — development of multiple organ failure.
 Conclusions. The implemented set of preventive measures ensured the patient’s protection from COVID‑19 infection in all cases during their hospital stay. In liver transplant patients.