Impact of COVID-19 in patients awaiting liver transplantation

ABSTRACT

Background: During the SARS-CoV2 pandemic, health authorities employed multiple interventions to prevent the spread of the disease Despite these measures, liver transplantation (LT) has never been suspended during this period However, care for patients awaiting LT had to be sometimes delayed The objective of this study was to assess the impact of COVID-19 in patients awaiting LT, the number of patients infected, the risk factors for infection, and the patients' experience during the crisis Methods: This is a mono-center French study, based on anonymous questionnaire completed by patients active on waiting list (WL) of the Paul Brousse hospital on April 2020 Patients were divided into two groups non-suspect for COVID-19, and suspect or confirmed. Suspect patients were defined presence of at least one of the following clinical manifestations fever, chills, aches, dyspnea, anosmia, agueusia, diarrhea, cough. Confirmed COVID-19 patients were defined as SARS-CoV-2 positive PCR or typical COVID-19 images on the chest CT scan Results: Ninety patients were included in the study Indication of LT was cirrhosis for 45 (49%) patients and hepatocellular carcinoma (HCC) for 32 (35%) patients Thirty-one (34%) patients had signs of decompensated cirrhosis Fourteen (15%) patients were suspected for COVID-19 The PCR test was performed in 17 (19%) patients and was positive for 2 (12%) patients A chest CT scan was performed in 29 (32%) patients and was positive for 1 (3.6%) patient. The 3 confirmed patients (3.3%) were hospitalized in a conventional unit, while 2 patients were transferred on ICU In multivariate analysis, the independent factors associated with a suspected or confirmed COVID-19 infection were the use of corticosteroids (OR 7 30, IC = 1 52;35 7, p = 0 011) and the use of aspirin (OR -9 87, IC = 1 92;56 7, p - 0 01) Sixty (71%) patients declared as feeling more at risk for COVID-19 than the general population and 86 (97%) patients respected confinement to the letter. Conclusion: Few active patients on WL for LT had a suspected (15 3%) or confirmed (3.3%) COVID-19. This can be explained by the global respect of confinement. The use of aspirin and corticosteroids were independent factors of suspected or confirmed COVID-19 in this population.