INCIDENCE AND MORTALITY OF COVID-19 IN POST-LIVER TRANSPLANT PATIENTS IN A LARGE INTEGRATED HEALTHCARE SYSTEM

ABSTRACT

Background The incidence and severity of COVID-19 among liver transplant (LT) recipients is not clearly elucidated in the current literature. Liver transplant recipients are often on immunosuppression regimens which can increase their risk of developing more severe infections. Current studies in literature report mortality rates in hospitalized solid organ transplant recipients ranging from 0% in small cohort in San Francisco to 20.5% in a large multi-center cohort in New York City. Our study aims to identify the incidence and mortality of COVID-19 infections in a large population of liver transplant recipients. Methods In a large integrated healthcare system in Southern California with a population of 4.7 million active members, data was extracted from the electronic health records (EHR) between March 2020 to November 2020. ICD 10 codes were used to identify patients who were persons under investigation (PUI) and who were confirmed to have COVID-19. PUIs were defined as those suspected, screened, or exposed to other COVID-19 patients. Data was joined with laboratory data to identify it the COVID-19 tests were performed. Diagnoses for PUI and confirmed cases were also pulled from patient notes using text analysis and problem lists. Demographic data was extracted from the EHR. Results We identified 1,253 active members who had received a LT as of 12/1/2020. Of these LT recipients, 86% (1,081/1,253) were more than 1-year post-transplant. In the post-LT cohort, 112 (8.9%) were at one point considered persons under investigation (PUI) and 31 (2.5%) were confirmed to have COVID-19. The incidence of confirmed COVID-19 in the overall population within the integrated healthcare system was 3.2%. Of the 31 post-LT patients with confirmed COVID-19, 54.8% (17/31) were male, 45.2% (14/31) were age 45-64, and 51.6% (16/31) were age 65 or older. The predominant ethnicity was Hispanic 67.7% (21/31) followed by White 22.6% (7/31), multiracial 6.5% (2/31), and Black 3.2% (1/31). The overall mortality in this cohort was 6.5% (2/31). Both deaths were in patients age 65-74 and occurred early in the pandemic in the months of April and May of 2020. As shown in Table 1, from the months of June to November of 2020, there were zero deaths from COVID-19 in this cohort. Conclusions The incidence of COVID-19 in a large cohort of post-LT patients (2.5%) in Southern California is lower than in the overall general population (3.2%). The mortality rate in postLT patients confirmed to have COVID-19 was 6.5%. Furthermore, the mortality rate appears to be declining over time. In our post-LT cohort, the most affected ethnicity was Hispanic, and mortality occurred in older age groups—reflecting known trends in the general population. (Table presented.)