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COVID-19 in Liver Transplant Candidates: Pre- and Post-Transplant Outcome

25 Pages Posted: 29 Mar 2021

See all articles by Luca Saverio Belli

Luca Saverio Belli

Grande Ospedale Metropolitano Niguarda - Hepatology and Gastroenterology Unit

Christophe Duvoux

affiliation not provided to SSRN

Paolo Cortesi

affiliation not provided to SSRN

Speranta Iacob

affiliation not provided to SSRN

Rita Facchetti

affiliation not provided to SSRN

Sylvie Radenne

affiliation not provided to SSRN

Perricone Giovanni

affiliation not provided to SSRN

Sara Conti

affiliation not provided to SSRN

Damiano Patrono

affiliation not provided to SSRN

Gabriela Berlakovic

affiliation not provided to SSRN

Angus Hann

Government of the United Kingdom - Queen Elizabeth Hospital Birmingham

Luisa Pasulo

affiliation not provided to SSRN

Lluis Castells

Center for Biomedical Research in the Liver and Digestive Diseases Network (CIBERehd)

Francois Faitot

affiliation not provided to SSRN

Olivier Detry

University of Liege

Federica Invernzzi

affiliation not provided to SSRN

Giulia MAgini

affiliation not provided to SSRN

Paolo De Simone

University of Pisa - Department of Translational Research on New Technologies in Medicine and Surgery

Ilias Kounis

affiliation not provided to SSRN

Cristina Morelli

Regione Emilia-Romagna - IRCCS Azienda Ospedaliero-Universitaria di Bologna

Fernando Diaz-Fontenla

affiliation not provided to SSRN

Bo Goran Ericzon

affiliation not provided to SSRN

Carmelo Loinaz

Instituto de Investigación Sanitaria Hospital "12 de Octubre" - Department of Hepatology/HPB-surgery/Transplantation

Liana Gheorghe

affiliation not provided to SSRN

mickael lesurtel

affiliation not provided to SSRN

Renato Romagnoli

University of Turin

Dagmar Kollmann

affiliation not provided to SSRN

Thamara Perera

affiliation not provided to SSRN

Stefano Fagiuoli

Papa Giovanni XXIII Hospital

Darius Mirza

Government of the United Kingdom - Queen Elizabeth Hospital Birmingham

Audrey Coilly

affiliation not provided to SSRN

Christian Toso

affiliation not provided to SSRN

krzysztof zieniewicz

affiliation not provided to SSRN

Laurie Elkrief

affiliation not provided to SSRN

Vincent Karam

affiliation not provided to SSRN

Caroline Den Hoed

affiliation not provided to SSRN

Marco Merli

Grande Ospedale Metropolitano Niguarda - Division of Infectious Diseases

Massimo Puoti

Grande Ospedale Metropolitano Niguarda - Division of Infectious Diseases

Roberto fumagalli

Università degli Studi di Milano-Bicocca - School of Medicine and Surgery

Luciano De Carlis

University of Milan-Bicocca

Costantino Fondevila

Hospital Clinic of Barcelona - General & Digestive Surgery Service

Wojciech Polak

affiliation not provided to SSRN

More...

Abstract

Background: The impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course is presently unknown. 

Methods: Data from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and analyzed.

Findings: From February 21st to November 20th, 2020, 136 adult cases with laboratory confirmed SARS-CoV-2 infection from 33 centers in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32·7%) patients died after a median of 18 (10-30) days, respiratory failure being the major cause (33/37, 89·2%). The 60-day mortality risk did not significantly change between first (35·3%, 95% CI 23·9-50·0) and second wave (26·0%, 95% CI 16·2-40·2). Multivariable Cox regression analysis showed lab-MELD score ≥15 (MELD 15-19 HR 6·09, 95% CI 2·01-18·45; MELD ≥20 HR 5·21, 95% CI 1·76-15·45) and dyspnea on presentation (HR 4·10, 95% CI 2·09-8·06) being the two negative independent factors for mortality. The mortality risk reached 49·2% (31/63) in patients with decompensated cirrhosis and lab-MELD score ≥15. Twenty-six patient received a LT after a median time of 78.5 (IQR 44-102) days and 25 (96%) are alive after median follow-up of 118 days (IQR 31-170).

Interpretation: Increased mortality in LT candidates with COVID-19 (32·7%), reaching 49·2% in those with decompensated cirrhosis and lab-MELD score ≥15, with no significant difference between first and second wave of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with decompensated cirrhosis supports the adoption of strict preventative measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%).

Funding: No funding source.

Declaration of Interests: None to declare.

Ethics Approval Statement: Data was collected in accordance with General Data Protection Regulation (GDPR), the European Union legislation and the ELTR privacy policy. Reg. HCB/2020/0479 released by CLINICAL RESEARCH ETHICS COMMITTEE from Hospital Clinic Barcelona

Keywords: SARS-CoV-2 infection; COVID-19; Waiting list; Liver transplantation; Cirrhosis; Acute decompensation; Acute-on-chronic liver failure; Mortality

Suggested Citation

Belli, Luca Saverio and Duvoux, Christophe and Cortesi, Paolo and Iacob, Speranta and Facchetti, Rita and Radenne, Sylvie and Giovanni, Perricone and Conti, Sara and Patrono, Damiano and Berlakovic, Gabriela and Hann, Angus and Pasulo, Luisa and Castells, Lluis and Faitot, Francois and Detry, Olivier and Invernzzi, Federica and MAgini, Giulia and De Simone, Paolo and Kounis, Ilias and Morelli, Cristina and Diaz-Fontenla, Fernando and Ericzon, Bo Goran and Loinaz, Carmelo and Gheorghe, Liana and lesurtel, mickael and Romagnoli, Renato and Kollmann, Dagmar and Perera, Thamara and Fagiuoli, Stefano and Mirza, Darius and Coilly, Audrey and Toso, Christian and zieniewicz, krzysztof and Elkrief, Laurie and Karam, Vincent and Den Hoed, Caroline and Merli, Marco and Puoti, Massimo and fumagalli, Roberto and De Carlis, Luciano and Fondevila, Costantino and Polak, Wojciech, COVID-19 in Liver Transplant Candidates: Pre- and Post-Transplant Outcome. Available at SSRN: https://ssrn.com/abstract=3807320 or http://dx.doi.org/10.2139/ssrn.3807320

Luca Saverio Belli (Contact Author)

Grande Ospedale Metropolitano Niguarda - Hepatology and Gastroenterology Unit ( email )

Milan
Italy

Christophe Duvoux

affiliation not provided to SSRN

No Address Available

Paolo Cortesi

affiliation not provided to SSRN

No Address Available

Speranta Iacob

affiliation not provided to SSRN

No Address Available

Rita Facchetti

affiliation not provided to SSRN

No Address Available

Sylvie Radenne

affiliation not provided to SSRN

No Address Available

Perricone Giovanni

affiliation not provided to SSRN

No Address Available

Sara Conti

affiliation not provided to SSRN

No Address Available

Damiano Patrono

affiliation not provided to SSRN

No Address Available

Gabriela Berlakovic

affiliation not provided to SSRN

No Address Available

Angus Hann

Government of the United Kingdom - Queen Elizabeth Hospital Birmingham

Mindelsohn Way
Birmingham, B15 2TH
United Kingdom

Luisa Pasulo

affiliation not provided to SSRN

No Address Available

Lluis Castells

Center for Biomedical Research in the Liver and Digestive Diseases Network (CIBERehd)

48160 Derio, Bizkaia
Spain

Francois Faitot

affiliation not provided to SSRN

No Address Available

Olivier Detry

University of Liege ( email )

Federica Invernzzi

affiliation not provided to SSRN

No Address Available

Giulia MAgini

affiliation not provided to SSRN

No Address Available

Paolo De Simone

University of Pisa - Department of Translational Research on New Technologies in Medicine and Surgery

Italy

Ilias Kounis

affiliation not provided to SSRN

No Address Available

Cristina Morelli

Regione Emilia-Romagna - IRCCS Azienda Ospedaliero-Universitaria di Bologna ( email )

Fernando Diaz-Fontenla

affiliation not provided to SSRN

No Address Available

Bo Goran Ericzon

affiliation not provided to SSRN

No Address Available

Carmelo Loinaz

Instituto de Investigación Sanitaria Hospital "12 de Octubre" - Department of Hepatology/HPB-surgery/Transplantation

Madrid
Spain

Liana Gheorghe

affiliation not provided to SSRN

No Address Available

Mickael Lesurtel

affiliation not provided to SSRN

No Address Available

Renato Romagnoli

University of Turin

Via Po 53
Torino, Turin - Piedmont 10100
Italy

Dagmar Kollmann

affiliation not provided to SSRN

No Address Available

Thamara Perera

affiliation not provided to SSRN

No Address Available

Stefano Fagiuoli

Papa Giovanni XXIII Hospital

Bergamo
Italy

Darius Mirza

Government of the United Kingdom - Queen Elizabeth Hospital Birmingham

Mindelsohn Way
Birmingham, B15 2TH
United Kingdom

Audrey Coilly

affiliation not provided to SSRN

No Address Available

Christian Toso

affiliation not provided to SSRN

No Address Available

Krzysztof Zieniewicz

affiliation not provided to SSRN

No Address Available

Laurie Elkrief

affiliation not provided to SSRN

No Address Available

Vincent Karam

affiliation not provided to SSRN

No Address Available

Caroline Den Hoed

affiliation not provided to SSRN

No Address Available

Marco Merli

Grande Ospedale Metropolitano Niguarda - Division of Infectious Diseases

Milan
Italy

Massimo Puoti

Grande Ospedale Metropolitano Niguarda - Division of Infectious Diseases

Milan
Italy

Roberto Fumagalli

Università degli Studi di Milano-Bicocca - School of Medicine and Surgery

Piazza dell'Ateneo Nuovo, 1
Milano, 20126
Italy

Luciano De Carlis

University of Milan-Bicocca ( email )

Costantino Fondevila

Hospital Clinic of Barcelona - General & Digestive Surgery Service ( email )

Barcelona
Spain

Wojciech Polak

affiliation not provided to SSRN

No Address Available