Varied clinical presentation and outcome of SARS-CoV-2 infection in liver transplant recipients: Initial experience at a single center in Madrid, Spain

Transpl Infect Dis. 2020 Oct;22(5):e13372. doi: 10.1111/tid.13372. Epub 2020 Jul 1.

Abstract

Background: Which are the consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in liver transplant (LT) recipients?

Methods: We attempted to address this question by reviewing our single-center experience during the first 2 months of the pandemics at a high incidence area.

Results: Nineteen adult patients (5 females) were diagnosed by May 5, 2020. Median age was 58 (range 55-72), and median follow-up since transplantation was 83 (range 20-183) months. Cough (84.2%), fever (57.9%), and dyspnea (47.4%) were the most common symptoms. Thirteen patients (68.4%) had pneumonia in x-ray/CT scan. Hydroxychloroquine was administered in 11 patients, associated with lopinavir/ritonavir and interferon β in 2 cases each. Immunomodulatory therapy with tocilizumab was used in 2 patients. Immunosuppression (IS) was halted in one patient and modified in only other two due to potential drug interactions. Five (26.3%) patients were managed as outpatient. Two patients (10.5%) died, 10 (52.6%) were discharged home, and 2 (10.5%) were still hospitalized after a median follow-up of 41 days from the onset of symptoms. Baseline IS regimen remained unchanged in all surviving recipients, with good liver function.

Conclusions: Our preliminary experience shows a broad spectrum of disease severity in LT patients with COVID-19, with a favorable outcome in most of them without needing to modify baseline IS.

Keywords: COVID-19; SARS-CoV2; immunosuppression; liver transplant; prognosis.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antiviral Agents / therapeutic use
  • COVID-19 / diagnosis*
  • COVID-19 / epidemiology
  • COVID-19 / immunology
  • COVID-19 Drug Treatment
  • Female
  • Follow-Up Studies
  • Graft Rejection / immunology
  • Graft Rejection / prevention & control
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Immunocompromised Host
  • Immunosuppressive Agents / adverse effects*
  • Liver Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Pandemics
  • Prospective Studies
  • Retrospective Studies
  • SARS-CoV-2 / immunology*
  • SARS-CoV-2 / isolation & purification
  • Severity of Illness Index
  • Spain / epidemiology
  • Transplant Recipients
  • Treatment Outcome

Substances

  • Antibodies, Monoclonal, Humanized
  • Antiviral Agents
  • Immunosuppressive Agents
  • Hydroxychloroquine
  • tocilizumab