Clinical outcomes in liver/kidney transplant patients with covoid infection: experience from a single center

ABSTRACT

Introduction: Patients with liver (L) and/or kidney (K) transplants might be at increased risk of adverse outcomes from COVID-19 because of coexisting comorbidities and use of immunosuppressants. We aimed to assess the clinical outcomes in L/K patients, clinical characteristics of patients requiring hospitalization, pattern of liver injury, mortality rate and changes made in immunosuppression regimen. Methods: In this single cohort study, we collected data on 21 patients with laboratory-confirmed COVID infection, who had previously received liver and/or kidney transplant. Results: 6 patients (pts) underwent L+K transplant and 15 patients L alone. 8 pts were hospitalized and 13 pts stayed at home and completed quarantine. Mean age at the time of COVID infection was 58.4±12.4 and mean BMI 30.6±4.8. Patients who require hospitalization for COVID were older (Median 64.5 [IQR 7.8] yr) compared to patients who stayed at home and completed quarantine (59 [23] yr), however the difference was not significant (P=0.3). Pts who require hospitalization for COVID infection were closer to the time of transplantation (3.2 [2.7] yr) compared to patients who stayed at home and completed quarantine (5.3[12.8]yr ), however the difference was not significant (P=0.2). Mean LFTs in hospitalized patients were ALT 65.9, AST 69.8, Bili 2.8, Alk Phos 121.5. Patients who were hospitalized, none of them required intubation or ICU stay. Out of 8 hospitalized pts, 3 patients developed AKI and 7 of them had history of DM. 5 of the hospitalized patients received IV steroids, 4 received Remdesivir and 2 patients needed Plaquenil during hospitalization. None of them needed liver biopsy. Myfortic was held in all hospitalized patients. Tacrolimus dose was decreased in 4 pts, not changed in 2 pts and increased in 1 patient. One patient was on cyclosporine and dose was decreased. Out of 21 total pts, one patient died and she was a female, 52 Years old with hx of ERSD on HD. In home quarantine group (13 pts), Tacrolimus dose did not require adjustments and Myfortic was increased one patient. Conclusion: We saw good outcome (no death) in transplant patients who got COVID and did not require hospitalization or change in immunosuppression. However, in hospitalized patient, we ended up stopping Myfortic and changes were made to tacrolimus, either complete stoppage, decreased dose and even increased dose in one patient. One LT patient who died was hospitalized with COVID and ESRD requiring HD was noted as a major comorbidity in that patient..