Epidemiological pattern, incidence, and outcomes of COVID-19 in liver transplant patients

JOURNAL OF HEPATOLOGY

卷:74

Article

Colmenero, Jordi^1,2  Rodriguez-Peralvarez, Manuel^2,3  Salcedo, Magdalena^2,4  Arias-Milla, Ana⁵  Munoz-Serrano, Alejandro⁵  Graus, Javier^2,6  Nuno, Javier⁷  Gastaca, Mikel⁸  Bustamante-Schneider, Javier⁸  Cachero, Alba⁹  Llado, Laura⁹  Caballero, Aranzazu^2,4  Fernandez-Yunquera, Ainhoa^2,4  Loinaz, Carmelo¹⁰  Fernandez, Inmaculada¹⁰  Fondevila, Constantino^1,2  Navasa, Miquel^1,2  Inarrairaegui, Mercedes^2,11  Castells, Lluis^2,12  Pascual, Sonia¹³  Ramirez, Pablo¹⁴  Vinaixa, Carmen^2,15  Luisa Gonzalez-Dieguez, Maria^16,17  Gonzalez-Grande, Rocio¹⁸  Hierro, Loreto¹⁹  Nogueras, Flor²⁰  Otero, Alejandra²¹  Maria Alamo, Jose²²  Blanco-Fernandez, Gerardo²³  Fabrega, Emilio^2,24  Garcia-Pajares, Fernando²⁵  Luis Montero, Jose^2,3  Tome, Santiago²⁶  De la Rosa, Gloria^27,28  Antonio Pons, Jose¹⁴ 

[1] Univ Barcelona, Hosp Clin, Liver Transplant Unit, IDIBAPS, Barcelona, Spain

[2] Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain

[3] Hosp Univ Reina Sofia, Dept Hepatol & Liver Transplantat, IMIBIC, Cordoba, Spain

[4] Univ Complutense, Hosp Gen Univ Gregorio Maranon, Hepatol & Liver Transplantat Unit, Madrid, Spain

[5] Univ Autonoma Madrid, Hosp Puerta Hierro, Hepatol & Liver Transplant Unit, IDIPHIMSA, Madrid, Spain

[6] Hosp Ramon & Cajal, Dept Digest Dis, IRYCIS, Madrid, Spain

[7] Hosp Univ Ramon Y Cajal, Hepatobiliary & Liver Transplantat Unit, Madrid, Spain

[8] Univ Basque Country, Cruces Univ Hosp, Biocruces Bizkaia Hlth Res Inst, Liver Transplantat Unit, Bilbao, Spain

[9] Hosp Univ Bellvitge, Liver Transplant Unit, IDIBELL, Barcelona, Spain

[10] Hosp Univ 12 Octubre, Dept Hepatol HPB Surg Transplantat, Madrid, Spain

[11] Clin Univ Navarra, Liver Unit, IDISNA, Pamplona, Spain

[12] Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Internal Med, Liver Unit, Barcelona, Spain

[13] Hosp Gen Univ Alicante, Liver Unit, Alicante, Spain

[14] Hosp Univ Virgen Arrixaca, Dept Surg, Liver Transplantat Unit, Liver Unit,IMIB, Murcia, Spain

[15] Hosp Univ & Politecn La Fe, Dept Hepatol & Liver Transplantat, Valencia, Spain

[16] Hosp Univ Cent Asturias, Liver Unit, Oviedo, Spain

[17] Hosp Univ Cent Asturias, Div Gastroenterol & Hepatol, Oviedo, Spain

[18] Hosp Reg Univ Malaga, Dept Liver Transplantat, Malaga, Spain

[19] Hosp Univ La Paz, Dept Paediat Hepatol & Liver Transplantat, Madrid, Spain

[20] Hosp Virgen Nieves, Dept Hepatol & Liver Transplantat, Granada, Spain

[21] Hosp A Coruna, Liver Transplant Unit, La Coruna, Spain

[22] Hosp Virgen Rocio, Liver Transplant Unit, Seville, Spain

[23] Complejo Hosp Univ Badajoz, Dept HPB Surg & Liver Transplantat, Badajoz, Spain

[24] Hosp Univ Marques Valdecilla, Dept Digest Dis, IDIVAL, Santander, Spain

[25] Hosp Rio Hortega Valladolid, Dept Liver Transplantat, Valladolid, Spain

[26] Hosp Univ Santiago, Dept Liver Transplantat, Santiago De Compostela, Spain

[27] Registro Espanol Trasplante Hepat RETH, Madrid, Spain

[28] Org Nacl Trasplantes ONT, Madrid, Spain

关键词: COVID-19;    SARS-CoV-2;    Pneumonia;    Epidemiology;    Transplantation;    Immunosuppression;    Mycophenolate;    Calcineurin inhibitors;    Tacrolimus;    Everolimus;    Standardised incidence;    Standardised mortality;   

DOI  :  10.1016/j.jhep.2020.07.040

来源: Elsevier

【 摘 要 】

Background & Aims: The incidence and outcomes of coronavirus disease 2019 (COVID-19) in immunocompromised patients are a matter of debate. Methods: We performed a prospective nationwide study including a consecutive cohort of liver transplant patients with COVID-19 recruited during the Spanish outbreak from 28 February to 7 April, 2020. The primary outcome was severe COVID-19, defined as the need for mechanical ventilation, intensive care, and/or death. Age- and gender-standardised incidence and mortality ratios (SIR and SMR) were calculated using data from the Ministry of Health and the Spanish liver transplant registry. Independent predictors of severe COVID-19 among hospitalised patients were analysed using multivariate Cox regression. Results: A total of 111 liver transplant patients were diagnosed with COVID-19 (SIR = 191.2 [95% CI 190.3-192.2]). The epidemiological curve and geographic distribution overlapped widely between the liver transplant and general populations. After a median follow-up of 23 days, 96 patients (86.5%) were admitted to hospital and 22 patients (19.8%) required respiratory support. A total of 12 patients were admitted to the ICU (10.8%). The mortality rate was 18%, which was lower than in the matched general population (SMR = 95.5 [95% CI 94.2-96.8]). Overall, 35 patients (31.5%) met criteria of severe COVID-19. Baseline immunosuppression containing mycophenolate was an independent predictor of severe COVID-19 (relative risk = 3.94; 95% CI 1.59-9.74; p = 0.003), particularly at doses higher than 1,000 mg/day (p = 0.003). This deleterious effect was not observed with calcineurin inhibitors or everolimus and complete immunosuppression withdrawal showed no benefit. Conclusions: Being chronically immunosuppressed, liver transplant patients have an increased risk of acquiring COVID-19 but their mortality rates are lower than the matched general population. Upon hospital admission, mycophenolate dose reduction or withdrawal could help in preventing severe COVID-19. However, complete immunosuppression withdrawal should be discouraged. Lay summary: In liver transplant patients, chronic immunosuppression increases the risk of acquiring COVID-19 but it could reduce disease severity. Complete immunosuppression withdrawal may not be justified. However, mycophenolate withdrawal or temporary conversion to calcineurin inhibitors or everolimus until disease resolution could be beneficial in hospitalised patients. (C) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

【 授权许可】

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