COVID-19 infection in liver transplant recipients: Clinical features and outcomes from a Canadian multicentre cohort

ABSTRACT

BACKGROUND: Prior studies have assessed risk factors and clinical outcomes in liver transplant (LT) recipients infected with COVID-19 globally;however, there is a paucity of Canadian data. Our multicentre study aims to examine the characteristics and clinical outcomes of LT patients with COVID-19 infection in Canada. METHODS: Adult LT recipients with reverse transcription-polymerase chain reaction (RT-PCR) confirmed COVID-19, from Canadian tertiary care centres between March 2020 and June 2021 were included. RESULTS: A total of 49 patients with a history of LT and COVID-19 infection were identified. Twenty nine patients (59%) were male, median time from LT was 66 months (IQR 1, 128), and median age was 59 years (IQR 52, 65). At COVID-19 diagnosis, the median alanine transaminase (ALT) was 37 U/L (IQR 21, 41), aspartate aminotransferase (AST) U/L was 34 (IQR 20, 37), alkaline phosphatase (ALP) U/L was 156 (IQR 88, 156), total bilirubin was 11 umol/L (IQR 7, 14), and international normalized ratio (INR) was 1.1 (IQR 1.0, 1.1). The majority of patients (86%) were on tacrolimus (monotherapy or combined with mycophenolate mofetil);median tacrolimus level at COVID-19 diagnosis was 5.3 ug/L (IQR 4.0, 8.1). Immunosuppression was modified in eight (16%) patients post-infection. Eighteen patients (37%) required hospitalization, and three (6%) required intensive care unit (ICU) admission and mechanical ventilation. Four patients (8%) died from complications related to COVID-19 infection. On univariate analysis, neither age, sex, comorbidities nor duration post-transplant were associated with risk of hospitalization or ICU admission. CONCLUSIONS: LT recipients with COVID-19 have high rates of hospitalization but fortunately have low rates of ICU admission and mortality in this national registry.