Outcomes of patients with decompensated cirrhosis and coronavirus disease 19: Mortality and safety of liver transplantation

ABSTRACT

Introduction: Outcomes of patients with decompensated cirrhosis and coronavirus disease 19 (COVID-19) is not clear yet. There is also major concerns about management, timing and safety of liver transplantation in patients recovered from COVID-19. This study aimed to investigate clinical outcomes of patients with decompensated cirrhosis with COVID-19. Aims & Methods: A retrospective study was conducted on patients with decompensated cirrhosis and COVID-19 who referred to our center between April, 1, 2020 and March, 30, 2021. COVID-19 was diagnosed if nasopharyngeal swabs reverse transcription polymerase chain reaction (RTPCR) for SARS-Cov-2 was positive. Decompensated cirrhosis was defined as liver cirrhosis with any of these complications variceal bleeding, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome. Acute on chronic liver failure (ACLF) was defined and graded using EASL-CLIF consortium. Clinical outcomes of patients including development of ACLF, mortality and liver transplantation were recorded. Results: Eighty two patients with decompensated liver cirrhosis and COVID- 19 were included. Mean age of patient was 52.34 ± 15.4 years. Non-alcoholic steatohepatitis (NASH) and autoimmune hepatitis (AIH) were most common causes of liver cirrhosis among patients. Fifty eight patients (70.7 %) either had or developed different grades of ACLF during hospitalization. Sixteen patients had grade 1 ACLF, 13 patients had grade 2 ACLF and 29 patients had grade 3 ACLF. Higher age (P < 0.001), presence of ACLF (P < 0.001) and grade 3 ACLF (P < 0.001) were predictors of mortality among our patients. Early liver transplantation (within 100 days from COVID-19 recovery) from deceased donor was performed on 17 patients with liver cirrhosis who recovered from COVID-19. Mortality was occurred in 3 patients after liver transplantation secondary to multi-organ failure and sepsis. Five patients had positive RT-PCR results for SARS-Cov-2 after liver transplantation which is probably due to prolonged viral shedding. Conclusion: Mortality is high among patients with decompensated cirrhosis and COVID-19 which is mainly secondary to presence and grade of ACLF. This is the largest series of patients with liver cirrhosis who underwent liver transplantation after recovery of COVID-19 showing that liver transplantation might be safe among this group of patients and should not be postponed when necessary.