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COVID-19 in liver transplant candidates: pretransplant and post-transplant outcomes - an ELITA/ELTR multicentre cohort study.
Belli, Luca Saverio; Duvoux, Christophe; Cortesi, Paolo Angelo; Facchetti, Rita; Iacob, Speranta; Perricone, Giovanni; Radenne, Sylvie; Conti, Sara; Patrono, Damiano; Berlakovich, Gabriela; Hann, Angus; Pasulo, Luisa; Castells, Lluis; Faitot, Francois; Detry, Olivier; Invernizzi, Federica; Magini, Giulia; De Simone, Paolo; Kounis, Ilias; Morelli, Maria Cristina; Díaz Fontenla, Fernando; Ericzon, Bo-Göran; Loinaz, Carmelo; Johnston, Chris; Gheorghe, Liliana; Lesurtel, Mickael; Romagnoli, Renato; Kollmann, Dagmar; Perera, M Thamara Pr; Fagiuoli, Stefano; Mirza, Darius; Coilly, Audrey; Toso, Christian; Zieniewicz, Krzysztof; Elkrief, Laure; Karam, Vincent; Adam, Rene; den Hoed, Caroline; Merli, Marco; Puoti, Massimo; De Carlis, Luciano; Oniscu, Gabriel C; Piano, Salvatore; Angeli, Paolo; Fondevila, Constantino; Polak, Wojciech G.
  • Belli LS; Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy luca.belli@ospedaleniguarda.it.
  • Duvoux C; Hepatology, Hopital Henri Mondor, Creteil, France.
  • Cortesi PA; Research Centre on Public Health (CESP), Universita degli Studi di Milano-Bicocca Scuola di Medicina e Chirurgia, Monza, Italy.
  • Facchetti R; Research Centre on Public Health (CESP), Universita degli Studi di Milano-Bicocca Scuola di Medicina e Chirurgia, Monza, Italy.
  • Iacob S; Digestive Diseases and Liver Transplantation Center, Institutul Clinic Fundeni, Bucharest, Romania.
  • Perricone G; Epatologia e Gastroenterologia, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
  • Radenne S; Service Hépatologie et Gastro-Entérologie, Hospital Croix-Rousse, Lyon, France.
  • Conti S; Research Centre on Public Health (CESP), Università degli Studi di Milano-Bicocca, Milano, Italy.
  • Patrono D; Liver Transplantation Unit, Ospedale Molinette, Torino, Italy.
  • Berlakovich G; Division of Transplantation, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
  • Hann A; Department of Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
  • Pasulo L; Gastroenterology and Transplant Hepatology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
  • Castells L; Liver Transplant Unit, HPB Surgery and Transplants, Hospital Vall d'Hebron, Barcelona, Spain.
  • Faitot F; Service de Chirurgie Hepatobiliare and Transplantation, Hôpital de Hautepierre, Strasbourg, France.
  • Detry O; Department of Abdominal Surgery and Transplantation, CHU Liege, University of Liege, Liege, Belgium.
  • Invernizzi F; Division of Gastroenterology and Hepatology, Policlinico di Milano, Milan, Italy.
  • Magini G; Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, Geneve, Switzerland.
  • De Simone P; Trapiantologia Epatica Universitaria, Ospedale Cisanello, Pisa, Italy.
  • Kounis I; Centre Hépatobiliaire, Hospital Paul Brousse, Villejuif, France.
  • Morelli MC; Department of Organ Failures and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
  • Díaz Fontenla F; Liver Transplantation Unit, Hospital General Universitario Gregorio Maranon, Madrid, Spain.
  • Ericzon BG; Transplantation Surgery, Karolinska Institute, Stockholm, Sweden.
  • Loinaz C; HBP and Transplant Unit, Hospital Universitario 12 de Octubre, Madrid, Spain.
  • Johnston C; Liver Transplantation Unit, Edinburgh Royal Infirmary, Edinburgh, Edinburgh, UK.
  • Gheorghe L; Digestive Diseases and Liver Transplantation Center, Clinical Institute Fundeni, Bucuresti, Romania.
  • Lesurtel M; Department of Surgery and Transplanattion, Hospital Croix-Rousse, Lyon, Rhône-Alpes, France.
  • Romagnoli R; Liver Transplantation Unit, Ospedale Molinette, Torino, Italy.
  • Kollmann D; Division of Transplantation, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
  • Perera MTP; Department of Surgery, Queen Elizabeth Hospital, Birmingham, Birmingham, UK.
  • Fagiuoli S; Department of Gastroenterology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Lombardia, Italy.
  • Mirza D; Department of Surgery, Queen Elizabeth Hospital, Birmingham, Birmingham, UK.
  • Coilly A; Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, Île-de-France, France.
  • Toso C; UMR-S1193, INSERM, Villejuif, Île-de-France, France.
  • Zieniewicz K; Department of Surgery, Geneva University Hospitals, Geneve, Switzerland.
  • Elkrief L; Department of General, Transplant and Liver Surgery, Faculty of Medicine, Medical University of Warsaw, Warszawa, Poland.
  • Karam V; Hepatogastroenterology Unit, Hopital Trousseau, Chambray-les-Tours, France.
  • Adam R; Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France.
  • den Hoed C; Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France.
  • Merli M; Gastroenterology and Hepatology, Rotterdam, The Netherlands.
  • Puoti M; Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
  • De Carlis L; Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
  • Oniscu GC; Chirurgia Generale e dei Trapianti, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
  • Piano S; Transplantation Surgery, Karolinska Institute, Stockholm, Sweden.
  • Angeli P; Department of Medicine, Faculty of Medicine and Surgery, University of Padua, Padova, Italy.
  • Fondevila C; Department of Medicine, Faculty of Medicine and Surgery, University of Padua, Padova, Italy.
  • Polak WG; General and Digestive Surgery, Hospital Clinic de Barcelona, Barcelona, Spain.
Gut ; 70(10): 1914-1924, 2021 10.
Article in English | MEDLINE | ID: covidwho-1318040
ABSTRACT

OBJECTIVE:

Explore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course.

DESIGN:

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

RESULTS:

From 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres 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, with 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% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15-19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44-102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31-170).

CONCLUSIONS:

Increased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with DC 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%).
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Liver Transplantation / Transplant Recipients / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Vaccines Limits: Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Gut Year: 2021 Document Type: Article Affiliation country: Gutjnl-2021-324879

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Liver Transplantation / Transplant Recipients / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Vaccines Limits: Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Gut Year: 2021 Document Type: Article Affiliation country: Gutjnl-2021-324879