• There was no association between liver transplantation and a higher risk of death due to COVID-19.

• When treating patients with COVID-19, doctors should weigh other coexisting comorbidities over transplantation status. 

• Old age and comorbidities had more obvious association with increased risk of death.

• Limitations of the study included the small sample size, differences in treatment approach, and other important factors not accounted for in this study.

University of California, Davis

It was originally thought that patients with liver transplants could experience more severe consequences of a COVID-19 infection due to other comorbidities and patients' intake of immunosuppressants. The results of an international registry study show that patients with liver transplants did not have an increased risk of mortality, but rather those who are of old age, male sex, have high serum creatinine concentration, or existing diseases did tend to have a higher risk of COVID-19 related mortality.

Liver Transplant and COVID-19 Study

Webb, G. J., Marjot, T., Cook, J. A., Aloman, C., Armstrong, M. J., Brenner, E. J., Catana, M.-A., Cargill, T., Dhanasekaran, R., García-Juárez, I., Hagström, H., Kennedy, J. M., Marshall, A., Masson, S., Mercer, C. J., Perumalswami, P. V., Ruiz, I., Thaker, S., Ufere, N. N., … Moon, A. M. (2020). Outcomes following SARS-CoV-2 infection in liver transplant recipients: an international registry study. The Lancet Gastroenterology & Hepatology, N/A. https://doi.org/10.1016/s2468-1253(20)30271-5

Outcomes following SARS-CoV-2 infection in liver transplant recipients: an international registry study

- This multicentre cohort study was done by studying two cohorts: liver transplant and no liver transplant.
- The data collected for the liver transplant cohort was from known registries online. The data collected for the comparison cohort was from the Oxford University Hospitals National Health Service Foundation Trust in the UK.
- Liver injuries were assessed by the patients' peak serum alanine aminotransferase activity and divided into three levels of mild, moderate, and severe injuries. Acute kidney injury was also identified.
- Obesity was assumed absent.
- White ethnicity was the majority of the transplant cohort and assumed in the comparison cohort.
- 1:1 propensity score-matched samples were used to analyze the data. The treatment variable was transplantation status and treatment outcome was death. Covariates included age(years), sex, ethnicity, obesity, diabetes, hypertension, and baseline serum creatinine concentration(mg/dL).

Methods of the Liver Transplant and COVID-19 Study

• More of the patients who underwent liver transplants had gastrointestinal symptoms at the time of COVID-19 diagnosis.

• 31% of the liver transplant cohort and 30% of the comparison cohort met the requirements for ICU admission.

• 27% of the non-liver transplant cohort died compared to only 19% of the liver transplant cohort.

• There was no liver-related deaths. Most of the deaths were due to COVID-19 lung disease.

• There was no association between liver transplant status and risk of death due to COVID-19.

• Among the patients that had liver transplants, increased age, non-liver cancer diagnosis, and higher baseline serum creatinine showed strong correlation with death.

• Among the patients without liver transplants, increased age, male sex, white ethnicity, heart disease, diabetes, chronic lung diseases, hypertension, and non-liver cancer increased the risk of death following COVID-19 infection.

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