Liver Injury in Liver Transplant Recipients With Coronavirus Disease 2019 (COVID‐19): U.S. Multicenter Experience
Year: 2020
Type: article
Study design: Observational Study
Abstract: BACKGROUND AND AIMS: Coronavirus disease 2019 (COVID-19) is associated with liver injury, but the prevalence and patterns of liver injury in liver transplantation (LT) recipients with COVID-19 are open for study. APPROACH AND RESULTS: We conducted a multicenter study in the United States of 112 adult LT recipients with COVID-19. Median age was 61 years (interquartile range, 20), 54.5% (n = 61) were male, and 39.3% (n = 44) Hispanic. Mortality rate was 22.3% (n = 25); 72.3% (n = 81) were hospitalized and 26.8% (n = 30) admitted to the intensive care unit (ICU). Analysis of peak values of alanine aminotransferase (ALT) during COVID-19 showed moderate liver injury (ALT 2-5× upper limit of normal [ULN]) in 22.2% (n = 18) and severe liver injury (ALT > 5× ULN) in 12.3% (n = 10). Compared to age- and sex-matched nontransplant patients with chronic liver disease and COVID-19 (n = 375), incidence of acute liver injury was lower in LT recipients (47.5% vs. 34.6%; P = 0.037). Variables associated with liver injury in LT recipients were younger age (P = 0.009; odds ratio [OR], 2.06; 95% confidence interval [CI], 1.20-3.54), Hispanic ethnicity (P = 0.011; OR, 6.01; 95% CI, 1.51-23.9), metabolic syndrome (P = 0.016; OR, 5.87; 95% CI, 1.38-24.99), vasopressor use (P = 0.018; OR, 7.34; 95% CI, 1.39-38.52), and antibiotic use (P = 0.046; OR, 6.93; 95% CI, 1.04-46.26). Reduction in immunosuppression (49.4%) was not associated with liver injury (P = 0.156) or mortality (P = 0.084). Liver injury during COVID-19 was significantly associated with mortality (P = 0.007; OR, 6.91; 95% CI, 1.68-28.48) and ICU admission (P = 0.007; OR, 7.93; 95% CI, 1.75-35.69) in LT recipients. CONCLUSIONS: Liver injury is associated with higher mortality and ICU admission in LT recipients with COVID-19. Hence, monitoring liver enzymes closely can help in early identification of patients at risk for adverse outcomes. Reduction of immunosuppression during COVID-19 did not increase risk for mortality or graft failure.
Source: Hepatology
DOI: 10.1002/hep.31574
Authors: Atoosa Rabiee, Brett Sadowski, Nia Adeniji, Ponni V. Perumalswami, Veronica Nguyen, Akshata Moghe, Nyan L. Latt, Sonal Kumar, Costica Aloman, Andreea M. Catana, Patricia P. Bloom, Kenneth D. Chavin, Rotonya M. Carr, Winston Dunn, Vincent L. Chen, Elizabeth S. Aby, Jose D. Debes, Renumathy Dhanasekaran
Institutions: Veterans Health Administration, Washington DC VA Medical Center, Georgetown University, Stanford Medicine, Stanford University, Icahn School of Medicine at Mount Sinai, University of Arizona, University of Pittsburgh, University of Pittsburgh Medical Center, Ochsner Medical Center, Weill Cornell Medicine, Rush University Medical Center, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, University Hospitals of Cleveland, University Hospitals Cleveland Medical Center, University of Pennsylvania, University of Kansas Medical Center, University of Michigan, University of Minnesota, Hennepin County Medical Center
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3087358376