Objective Explore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course.
Design Data from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and were analysed.
Results From 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32.7%) patients died after a median of 18 (10–30) days, with respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not significantly change between first (35.3%, 95% CI 23.9% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15–19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44–102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31–170).
Conclusions Increased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventative measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%).
- liver cirrhosis
- liver transplantation
Data availability statement
Data are available upon reasonable request. Contacts:Rita Facchetti, Rita.Facchetti@unimib.it; Paolo Cortesi, Paolo.firstname.lastname@example.org; IDOTCOVID platform.
This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.https://bmj.com/coronavirus/usage
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CF and WGP are joint senior authors.
LSB, CD and PAC are joint first authors.
Collaborators Raffaella Viganò, Chiara Mazzarelli, Andrea Lauterio, Alessandro Giacomoni, Giovanna Travi, Massimo Puoti, Francesca Donato, Pietro Lampertico, Michele Colledan, Marco Zambelli, Michela Guizzetti, Giovanni Vitale, Fabrizio Di Benedetto, Paola Carrai, Stefania Petruccelli,Simone Incicco, Nicola Zen, Baptiste Michard, Saliba Faouzi, Didier Samiuel, Norbert Ngongang, Domitille Poinsot, Celine Guichon, Emmanuel Gonzales, Gabriel Oniscu, Derek Manaz, Jordi Colmenero, David Toapanta, Ernest Hidalgo, Jose Maria Alamo,Esther Brea Gomes, Gerardo Blanco, Alberto Marcacuzco, Gonzalo Rodriguez, Sonia Pascual, Georg Györi, JAcques Pirenne, Natalie Vandende, Valerio Lucidi, Giulia Magini, Nicolas Goossens, Carl Jorns, Irinel Popescu and Joanna Raszeja-Wyszomirska.
Contributors LSB: conceptualisation, data curation and drafting and critical revision of the manuscript; RF, PAC and SC: formal analysis and critical revision of the manuscript; CF, WGP, CD and GP: conceptualisation, review and editing, and critical revision of the manuscript; SR, DP, GB, AH, LP, LC, FF, OD, FI, GM, PDS, IK, MCM, FDF, B-GE, CL, CJ, LG, ML, RR, DK, MTPRP, SF, DM, AC, CT, KZ, LE, VK, RA, CdH, MM, MP, LDC, SP, GO and PA: data curation and critical revision of the manuscript; SF and LDC: critical revision of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.