ABSTRACT
Background: SARS-CoV-2 has been shown to affect liver and GI tract in addition to primary involvement of lungs. Liver injury in COVID-19 is hypothesized to be multifactorial with 14- 73% of patients showing evidence of deranged liver functional. Data regarding the liver injury due to SARS CoV-2 infection in a large cohort of unselected patients, is limited, especially from India. So, we conducted a retrospective study among consecutive patients admitted with COVID-19 disease to a tertiary care hospital during the first wave of pandemic. Methods: It was a retrospective observational study. Consecutive patients infected with SARS- CoV-2 and admitted to the COVID-19 ward or ICU of our hospital between 1/4/2020 to 30/6/2020 were included. Patients, < 18 years of age, pregnant ladies and those with underlying liver disease were excluded. Detail history along with data on laboratory parameters, treatment given and outcomes (need for oxygen therapy, ICU admission, need for ventilatory support and in-hospital mortality) was collected and analysed. Results: Data on 303 patients was analysed after exclusions. The mean age was 47.9(15.9) years and 214(69.5%) were males. Out of 303 patients 149 (49.2%) had liver injury. Mild liver injury was present in 95(31.3%), moderate to severe liver injury in 54 (17.8%) patients and only 5 (1.6%) had severe liver injury. Pure cholestatic liver injury was present 19 (6.2%) cases. Male sex (82.1% vs 58.5%;P<0.001) and presence of symptoms (97.3% vs 90.8%;P= 0.01) were associated with presence of liver injury. Patients who had liver injury had significantly longer duration of symptoms before presentation [6 (3-8) days vs 4 (3-7) days);P=0.02] and higher serum ferritin levels [322(156-552) vs 151(44.9-299.5) ng/ml;P=0.02]. On multivariate analysis, serum ferritin was the only factor, independently associated with liver injury (OR- 1.002;95% CI- 1.001-1.004;P=0.006). Serum ferritin had a positive correlation with AST [r=0.416;P=0.0001] and ALT [R=0.458;P =0.0001] in the entire cohort. Liver injury was not significantly associated with need of oxygen therapy, ICU stay, mechanical ventilation or mortality but patients with moderate-severe liver injury had a longer hospital stay than those without [12.2 (5.07) vs 10.3 (4.84) days;P=0.01]. Conclusion: In COVID-19 patients, liver injury at presentation is common in symptomatic male patients and occurs around the end of first week and correlates strongly with serum ferritin levels, suggesting that it might be driven by immuno-inflammation.
ABSTRACT
Primary sclerosing cholangitis (PSC) is a cholestatic disorder wherein liver transplant is the definitive treatment for advance stages. However, recurrence of PSC after liver transplant is of concern which can leads to graft failure and may require retransplant. There is limited data on outcomes of living donor liver transplant (LDLT) in PSC. Also, in LDLT as donors are related there is possibility of disease recurrence. So, we conducted this retrospective study to analyse the outcomes of LDLT in PSC at a tertiary liver transplant centre in north India. Methods: We conducted a retrospective analysis of 3213 transplant recipients who underwent LDLT from January 2006 to May 2021. Of these 26 (0.80%) patients has PSC as indication for liver transplantation (PSC=24, PSC/AIH overlaP=2). Data analysis was done to look for baseline demographics, clinical details, transplant outcomes, PSC recurrence and survival. Results: Mean age of study group was 42(±13.8) years and 19 (73.1%) were males. All patients had decompensated cirrhosis at time of transplant. Mean CTP score and MELD score were 9.5(±1.8) and 18.9(±7.1) respectively. 16 patients received modified right lobe graft, 7 extended right lobe graft and 5 patients received left lateral graft. Average graft weight and GRWR were 633.5(IQR 473.5-633.5) grams and 1.23(SD±0.42) respectively. Most common biliary anastomosis was hepaticojejunostomy, done in 19(73.1%) while duct to duct anastomosis was performed in 7(26.9%) patients. Median follow- up was 96(36-123) months. One patient had ulcerative colitis and none had cholangiocarcinoma. Two (7.7%) patients had bile leak during early post-transplant period. Three (11.1%) patients developed graft rejection and managed successfully with steroid pulses. Three patients died during early post-transplant period while 7 deaths occurred during long term follow-up including one death due to COVID-19. Five (19.2%) patients had recurrence of PSC of which 2 patients lost their grafts including one after retransplantation. The overall 1 year and 5-year survival rates were 88.5% and 75% respectively. Conclusion: LDLT can be performed in PSC with good long-term outcomes with a risk of PSC recurrence in about 1/5th patients.
ABSTRACT
Background: Primary sclerosing cholangitis (PSC) is a cholestatic disorder wherein liver transplant is the definitive treatment for advance stages. However, recurrence of PSC after liver transplant is of concern which can leads to graft failure and may require retransplant. There is limited data on outcomes of living donor liver transplant (LDLT) in PSC. Also, in LDLT as donors are related there is possibility of disease recurrence. So, we conducted this retrospective study to analyze the outcomes of LDLT in PSC at a tertiary liver transplant centre in north India. Methods: We conducted a retrospective analysis of 3213 transplant recipients who underwent LDLT from January 2006 to May 2021. Of these 26 (0.80%) patients has PSC as indication for liver transplantation (PSC=24, PSC/AIH overlap=2). Data analysis was done to look for baseline demographics, clinical details, transplant outcomes, PSC recurrence and survival. Results: Mean age of study group was 42(±13.8) years and 19 (73.1%) were males. All patients had decompensated cirrhosis at time of transplant. Mean CTP score and MELD score were 9.5(±1.8) and 18.9(±7.1) respectively. 16 patients received modified right lobe graft, 7 extended right lobe graft and 5 patients received left lateral graft. Average graft weight and GRWR were 633.5(IQR 473.5-633.5) grams and 1.23(SD±0.42) respectively. Most common biliary anastomosis was hepaticojejunostomy, done in 19(73.1%) while duct to duct anastomosis was performed in 7(26.9%) patients. Median follow-up was 96(36-123) months. One patient had ulcerative colitis and none had cholangiocarcinoma. Two (7.7%) patients had bile leak during early post-transplant period. Three (11.1%) patients developed graft rejection and managed successfully with steroid pulses. Three patients died during early posttransplant period while 7 deaths occurred during long term follow-up including one death due to COVID-19. Five (19.2%) patients had recurrence of PSC of which 2 patients lost their grafts including one after retransplantation. The overall 1 year and 5-year survival rates were 88.5% and 75% respectively. Conclusion: LDLT can be performed in PSC with good longterm outcomes with a risk of PSC recurrence in about 1/5th patients.