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Indian Journal of Transplantation ; 16(1):8-16, 2022.
Article in English | EMBASE | ID: covidwho-1798829


COVID has drastically impacted organ donation across the world, leading to untold misery for thousands of patients who have been waiting for organs. Early rules on the use of organs from COVID positive or affected donors were stringent due to the fear of spread of disease or thrombotic complications in patients who received these organs. However much has changed in the past two years. Most of our adult population has either been infected with COVID, or has received two doses of vaccine, or both. The current variant, despite being more infective, is associated with mild disease, especially in those who have been vaccinated Our armamentarium against severe COVID has improved dramatically in the past year- we have effective vaccines, monoclonal antibodies for treatment of mild COVID in high risk patients and post exposure and antiviral prophylaxis and treatment which can substantially reduce the risk of severe COVID requiring ICU admission. The risk of transmission of COVID infection has to be balanced against the risk of patients dying with end organ disease. We will have to learn to live with COVID- this also means investigating whether organs from donors who are, or have been COVID positive can be used with acceptable risk -benefit in selected patients with end stage organ failure. This document is a summary of evidence and information regarding donor screening for SARS-CoV-2 and considerations for organ acceptance from donors with a history of COVID-19.

Hepatology ; 74(SUPPL 1):319A-320A, 2021.
Article in English | EMBASE | ID: covidwho-1508699


Background: Liver Transplant recipients have an increased susceptibility to SARS CoV2 infection with a possible more severe disease course. There is paucity of data of SARSCoV2 infection in this cohort from Asia. We report on the data of an on-going APCOLIS-1 (APASL Liver Injury Spectrum, APCOLIS) registry with the aim to define the profile, risk factors for severity and predictors of survival among the liver transplant recipients. Methods: In a multinational study, data was recorded between April 2020 to May 2021 across 13 countries in Asia. The data was compiled on a survey monkey under the APASL COVID-19 study task force [NCT04345640]. We performed multivariate logistic regression to identify independent predictors of severity and all cause mortality among the liver transplant (LT) recipients suffering from COVID-19. Results: Altogether, 130 LT recipients were enrolled [mean age 53 ± 12 years, median post-transplant period, 54 months (range 2-77 months)]. Majority (92, 71% ) of the patients had undergone live-donor transplant. Severe COVID was seen in 21/130 (16%) and 17/130 (13%) required ICU care. COVID related organ failures (OF) were seen in 17 patients (13%), predominantly as respiratory (16/21, 76.2%) followed by renal (9/21, 42.8%) and circulatory (5/21, 23.8%) with ventilatory requirement in 12/21 (57.1%) of the severe cases. Among the baseline parameters age [HR=1.08, 95CI 1.01-1.16, p=0.03], presentation with dyspnea [HR=6.34, 95CI 1.78-22.9, p=0.004] and Neutrophil to Lymphocyte ratio (NLR) [HR=1.08, 95CI 1.01-1.17, p=0.04] independently predicted a severe course of the COVID-19 among LT recipients. The baseline NLR of 8.47 ± 1.45 peaked to 17.94 ± 3.68 in median of 15 days (range 1-37) among severe cases [p<0.001] indicating rapid progression of disease. Age above 55 years increased the disease severity with AUROC of 0.78, sensitivity of 72.7% and specificity of 74.8%. Time from LT, immunosuppression dosage or presence of co-morbidities did not influence the outcome. Graft dysfunction was seen in 21/130 (16%);predominantly as acute cellular rejection in 13/130 (10%) and graft failure 7/130 (5%). The all cause mortality was 8% (11/130). Among non-survivors, the baseline NLR of 4.88 ± 1.63 increased to a peak value of 25.14 ± 5.49 [p<0.001] i.e 5 folds. The baseline NLR [HR=1.17, 95CI 1.03-1.34, p=0.02], development of graft injury [HR=27.21, 95CI 2.55-290., p=0.006] and COVID related OF [ HR=21.87, 95CI 2.39-203.85, p=0.007] independently predicted mortality due to SARSCoV2 infection. Conclusion: COVID-19 infection precipitates a severe disease course in one fifth of the liver transplant recipients, leading to graft dysfunction and early mortality. LT recipients above 55 years of age, presenting with dyspnea and high NLR need to be specifically watched for a progressive disease course. Dynamic NLR determination can help in early stratification and referral to a specialized liver unit to improve outcomes.

Hepatology ; 74(SUPPL 1):334A-335A, 2021.
Article in English | EMBASE | ID: covidwho-1508698


Background: COVID-19 among liver transplant (LT) recipients varies with symptoms, severity, time from LT and with treatment from region to region. Here-with we report the clinical presentation, spectrum of disease and outcome from the Asia Pacific region. Methods: In this multinational study, data was recorded between April 2020 to May 2021 across 13 countries in Asia. The data was compiled on survey monkey under the APASL COVID-19 study task force [NCT04345640]. Severity of COVID infection was defined as per WHO guidelines. We analysed symptoms, demography, treatment, clinical course and treatment among LT patients with COVID-19. Results: Among a total 130 LT patients, males were 117 with mean age of 53±12 years and majority were live donor transplant (92,71%). The most common etiology of liver disease was ethanol (37, 28%) followed by NASH (28,22%) and cryptogenic(21,16%). Median post LT period was 54 months. Co-morbidity was present in 101 patients (78%), the most common being obesity (61,47%),followed by Diabetes (56,43%) and hypertension(30,23%). The presenting complaints were fever(82%), cough(61%), dyspnoea(29%) and diarrhoea(7%);8% were asymptomatic. Respiratory distress was seen in 29 (22%) cases;17 received only oxygen and 12 needed ventilator support. Prior to illness, only CNI was used as immunosuppressant in 30% (39), CNI & MMF in 31% (40) and in another 31% (40) mTOR inhibitors alone or with a CNI and triple regimen in 9%. During COVID, only low dose steroid was used in 50% (64), low dose CNI in mild to moderate ( 32%,41), complete avoidance of MMF in 4% cases where as low dose CNI and MMF in 16% (20) patients. Immunosuppression reintroduction done in 68% to pre-COVID dose and 28% were maintained on low dose CNI with steroids with close monitoring of LFT and pre-COVID dose was restarted after 14 days of recovery .4% had graft dysfunction leading to early augmentation of immunosuppression. Any antiviral was received by 36%, convalescent plasma by 26% and immunomodulators like tocilizumab or bevacizumab in 13%. Home care offered to 46% cases while those admitted, 41% were managed in ward only and 13% needed ICU admission. Graft function was unaffected in majority (109, 84%) but Acute Cellular Rejection was noted in 10% cases and DILI or other causes in 6%. Liver injury in the form of raised transaminases or bilirubin was noted in 19% at hospital stay and in 40% at presentation. Severe COVID was in 16% (21) cases with mortality in 8% (11). Conclusion: Compared to general population post-LT patients have an increased mortality due to COVID. Home based care could be feasible in only half of the patients.