Abstract
BackgroundImmunosuppression and comorbidities increase the risk of severe coronavirus disease-2019 (COVID-19) in solid organ transplant (SOT) recipients. The outcomes of COVID-19 in liver transplant (LT) recipients remain unclear. We aimed to analyse the outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in LT recipients.MethodsThe electronic databases were searched for articles published from 1 December 2019 to 20 May 2021 with MeSH terms COVID-19, SARS-CoV-2, and liver transplantation. Studies reporting outcomes in more than 10 LT recipients were included for analysis. LT vs non-LT patients with COVID-19 infection were compared for all-cause mortality, which was the primary outcome studied. We also evaluated the relation between the timing of COVID-19 infection post-LT (< one year vs > one year) and mortality.FindingsEighteen articles reporting 1,522 COVID-19 infected LT recipients were included for the systematic review. The mean age (standard deviation [SD]) was 60·38 (5·24) years, and 68·5% were men. The mean time (SD) to COVID-19 infection was 5·72 (1·75) years. Based on 17 studies (I2 = 7·34) among 1,481 LT recipients, the cumulative incidence of mortality was 17·4% (95% confidence interval [CI], 15·4–19·6). Mortality was comparable between LT (n = 610) and non-LT (n = 239,704) patients, based on four studies (odds ratio [OR], 0·8 [0·6–1·08]; P = 0·14). Additionally, there was no significant difference in mortality between those infected within one year vs after one year of LT (OR, 1·5 [0·63–3·56]; P = 0·35). The cumulative incidence of graft dysfunction was 2·3% (1·3–4·1). Nearly 23% (20·71–25) of the LT patients developed severe COVID-19 infection. Before infection, 71% and 49% of patients were on tacrolimus and mycophenolate mofetil, respectively. Immunosuppression was modified in 55·9% (38·1–72·2) patients after COVID-19 infection.InterpretationLT and non-LT patients with COVID-19 have a similar risk of adverse outcomes.
Highlights
Coronavirus disease-2019 (COVID-19) is a global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Cardiovascular and pulmonary diseases were more common in non-liver transplant (LT) patients, while diabetes was more common in LT recipients (Supplementary Table 2b)
Ten and three studies had New-Castle Ottawa scale (NOS) scores of 8À9, 6À7, and 5, respectively (Supplementary Table 5). This meta-analysis demonstrated (a) comparable mortality (17¢4%) in LT and non-LT COVID-19 patients, (b) 23% of infected patients develop severe disease, (c) hypertension, diabetes, and obesity were the common comorbidities in infected patients, (d) while 72% of patients were hospitalised, only 16% required intensive care unit (ICU) care, (e) while more LT recipients required hospitalisation than non-LT patients (OR, 1¢99 [1¢41À2¢8] P < 0¢001) the requirement for ICU care was comparable in both groups and (f) cumulative incidence of graft dysfunction was 2¢3% (1¢3À4¢1)
Summary
Coronavirus disease-2019 (COVID-19) is a global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We searched PubMed from 1 December 2019 to 20 May 2021 with MeSH terms COVID-19, SARS-CoV-2, and liver transplantation. No major systematic reviews and meta-analyses have described the clinical features, disease course, and outcomes of COVID-19 infected liver transplant (LT) recipients. We aimed to analyse the outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in LT recipients. Methods: The electronic databases were searched for articles published from 1 December 2019 to 20 May 2021 with MeSH terms COVID-19, SARS-CoV-2, and liver transplantation. LT vs non-LT patients with COVID-19 infection were compared for all-cause mortality, which was the primary outcome studied. Findings: Eighteen articles reporting 1,522 COVID-19 infected LT recipients were included for the systematic review. Mortality was comparable between LT (n = 610) and non-LT (n = 239,704) patients, based on four studies (odds ratio [OR], 0¢8 [0¢6À1¢08]; P = 0¢14).
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