IMPACT OF SARS-COV-2 INFECTION ON RECIPIENTS OF LIVER TRANSPLANT. REPORT OF A MEXICAN COHORT

ABSTRACT

Introduction: SARS-CoV-2 has caused the first pandemic of the 21st century with a toll of more than 5 million deaths. Although Mexico is one of the most affected countries, no information regarding liver transplant (LT) recipients is available to date. A higher risk of developing COVID-19 has been reported for these subjects in the literature (cumulative incidence 837.41 cases/105 patients vs. 311.93 cases/105 patients). However, a lower mortality has also been reported (18% vs 27.0% among patients older than 60 years, with no deaths recorded in younger LT recipients). This work aims to further examine these trends. Methods: The study was performed in a single center of liver transplantation in Mexico City. The records of all the LT recipients above 18 years old with COVID-19 confirmed by reverse transcription-polymerase chain reaction assay (RT-PCR) between March 2020 and November 2021 were included. Demographic data, comorbidities, cause and date of LT, the immunosuppressive therapy (IT), vaccination status, severity, indication and availability of intensive care unit (ICU) beds, and mortality were extracted. The main outcome was death. Secondary outcomes were severity and need of ICU. Results: Seventy-four LT recipients with SARS-CoV-2 infection were considered. The median age was 54.5 years (45.0-61.3) and 39 patients were men (52.7%). The predominant etiology in our cohort was HCV (27.0%) followed by NASH (21.6%). Mean time from transplantation to infection was 56.2 weeks (33-80). Twenty-one patients had at least 1 vaccine dose at the time of infection (28.4%);15 had a complete scheme (20.2%). Twenty-one (28.4%) patients had severe COVID-19 (Table 1). Overall mortality was 8.10%. No IT treatment was associated with a better or worse prognosis for the whole cohort. Among the vaccinated patients, 4 (19%) had severe COVID-19 with a mean age of 61 years (59-64) and 3 died (mortality 14.3%);All of them had a complete vaccination scheme (1 with BNT162b2, 2 with ChAdOx1 nCoV19) and were taking mycophenolate mofetil (MMF). Among the unvaccinated, 17 patients had a severe illness (32.8%) (Figure 1), mean age of 55 years (50-63) and 3 died (mortality 5.6%). However, none of the latter had an ICU bed available. Conclusions: We present the characteristics of LT recipients with SARS-CoV-2 infection at the largest LT center in Mexico. Overall mortality (8%) was lower than that reported in other cohorts of LT recipients and no patient under 57 years old died. A significant numerical reduction in severe cases and the need for critical care was found among vaccinated patients. An association was found between the use of MMF and mortality among vaccinated patients SARS-CoV-2 vaccination should be encouraged and its access guaranteed among LT recipients. (Figure Presented) (Table Presented)