TY - JOUR
T1 - Liver Injury in Liver Transplant Recipients With Coronavirus Disease 2019 (COVID-19)
T2 - U.S. Multicenter Experience
AU - the COLD Consortium
AU - Rabiee, Atoosa
AU - Sadowski, Brett
AU - Adeniji, Nia
AU - Perumalswami, Ponni V.
AU - Nguyen, Veronica
AU - Moghe, Akshata
AU - Latt, Nyan L.
AU - Kumar, Sonal
AU - Aloman, Costica
AU - Catana, Andreea M.
AU - Bloom, Patricia P.
AU - Chavin, Kenneth D.
AU - Carr, Rotonya M.
AU - Dunn, Winston
AU - Chen, Vincent L.
AU - Aby, Elizabeth S.
AU - Debes, Jose D.
AU - Dhanasekaran, Renumathy
AU - Kim, Donghee
AU - Roytman, Marina
AU - Viveiros, Kathleen
AU - Chan, Walter
AU - Li, Michael
AU - Vogel, Alexander
AU - Wegerman, Kara
AU - Lee, Tzu Hao
AU - Zhou, Kali
N1 - Funding Information:
We thank the following persons for their expertise and assistance throughout all aspects of our study: Zoe Reinus, Michael Daidone, Julia Sjoquist, Faruq Pradhan, Mohanad Al-Qaisi, Nael Haddad, Nicholas Blackstone, Katherine Marx, Susan McDermott, Alyson Kaplan, Mallori Ianelli, Julia Speiser, Angela Wong, Dhuha Alhankawi, Sunny Sandhu, Sameeha Khalid, Aalam Sohal, and Christina Gainey Jennifer Smart, Neil Marimoto for their administrative support. We also thank all of the first-line responders who are working tirelessly and with dedication to care for patients and their families during the COVID-19 crisis.
PY - 2020/12
Y1 - 2020/12
N2 - 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.
AB - 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.
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U2 - 10.1002/hep.31574
DO - 10.1002/hep.31574
M3 - Article
C2 - 32964510
AN - SCOPUS:85096695670
VL - 72
SP - 1900
EP - 1911
JO - Hepatology
JF - Hepatology
SN - 0270-9139
IS - 6
ER -