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Original research
COVID-19 in an international European liver transplant recipient cohort
  1. Chiara Becchetti1,
  2. Marco Fabrizio Zambelli2,
  3. Luisa Pasulo3,
  4. Maria Francesca Donato4,
  5. Federica Invernizzi4,
  6. Olivier Detry5,
  7. Géraldine Dahlqvist6,
  8. Olga Ciccarelli7,
  9. Maria Cristina Morelli8,
  10. Montserrat Fraga9,
  11. Gianluca Svegliati-Baroni10,11,
  12. Hans van Vlierberghe12,
  13. Minneke J Coenraad13,
  14. Mario Cristobal Romero14,
  15. Andrea de Gottardi15,
  16. Pierluigi Toniutto16,
  17. Luca Del Prete2,
  18. Claudia Abbati2,
  19. Didier Samuel17,
  20. Jacques Pirenne18,
  21. Frederik Nevens19,
  22. Jean-François Dufour1,20
  23. COVID-LT group
    1. 1 University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
    2. 2 Department of Surgery, General Surgery and Abdominal Transplant Unit, "Papa Giovanni XXIII" Hospital, Bergamo, Bergamo, Lombardia, Italy
    3. 3 Gastroenterology and Transplant Hepatology, “Papa Giovanni XXIII” Hospital, Bergamo, Bergamo, Lombardia, Italy
    4. 4 Transplant Hepatology Unit, Division of Gastroenterology and Hepatology, IRCSS Foundation Ca’ Granda, Maggiore Hospital Policlinico, CRC "A.M. and A. Migliavacca" Center of Liver Disease, Milan, Italy
    5. 5 Department of Abdominal Surgery and Transplantation, Central University Hospital of Liege, Liege, Belgium
    6. 6 Hepatogastroenterology Unit, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
    7. 7 Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
    8. 8 Department of Organ Failures and Transplantation, Universita degli Studi di Bologna Azienda Ospedaliera di Bologna Policlinico Sant'Orsola-Malpighi, Bologna, Emilia-Romagna, Italy
    9. 9 Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
    10. 10 Liver Injury and Transplant Unit, AOU Ospedali Riuniti di Ancona, Ancona, Marche, Italy
    11. 11 Department of Clinical and Molecular Sciences and Obesity Center, Polytechnic University of Marche, Ancona, Marche, Italy
    12. 12 Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium
    13. 13 Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
    14. 14 Department of Hepatology, General University hospital Gregorio Maranon, Madrid, Spain
    15. 15 Gastroenterology and Hepatology, Ente Ospedaliero Cantonale, Università della Svizzera Italiana, Lugano, Switzerland
    16. 16 Hepatology and Liver Transplant Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Friuli-Venezia Giulia, Italy
    17. 17 Centre Hépato-Biliaire, Paris-Saclay University, Inserm research unit, Hôpital Paul Brousse, Villejuif, France
    18. 18 Abdominal Transplant Surgery, KU Leuven Hospital, Leuven, Flanders, Belgium
    19. 19 Hepatology, KU Leuven Hospital, Leuven, Flanders, Belgium
    20. 20 Hepatology, Depertment of Biomedical Research, University of Bern, Bern, Switzerland
    1. Correspondence to Professor Jean-François Dufour, Hepatology, Department of Visceral Surgery and Medicine, Inselspital University Hospital Bern, Bern CH-3010, Switzerland; jean-francois.dufour{at}dbmr.unibe.ch

    Abstract

    Objective Knowledge on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in liver transplant recipients is lacking, particularly in terms of severity of the disease. The aim of this study was to describe the demographic, baseline clinical characteristics and early outcomes of a European cohort of liver transplant recipients with SARS-CoV-2 infection.

    Design We conducted an international prospective study across Europe on liver transplant recipients with SARS-CoV-2 infection confirmed by microbiological assay during the first outbreak of COVID-19 pandemic. Baseline characteristics, clinical presentation, management of immunosuppressive therapy and outcomes were collected.

    Results 57 patients were included (70% male, median (IQR) age at diagnosis 65 (57–70) years). 21 (37%), 32 (56%) and 21 (37%) patients had one cardiovascular disease, arterial hypertension and diabetes mellitus, respectively. The most common symptoms were fever (79%), cough (55%), dyspnoea (46%), fatigue or myalgia (56%) and GI symptoms (33%). Immunosuppression was reduced in 22 recipients (37%) and discontinued in 4 (7%). With this regard, no impact on outcome was observed. Forty-one (72%) subjects were hospitalised and 11 (19%) developed acute respiratory distress syndrome. Overall, we estimated a case fatality rate of 12% (95% CI 5% to 24%), which increased to 17% (95% CI 7% to 32%) among hospitalised patients. Five out of the seven patients who died had a history of cancer.

    Conclusion In this European multicentre prospective study of liver transplant recipients, COVID-19 was associated with an overall and in-hospital fatality rate of 12% (95% CI 5% to 24%) and 17% (95% CI 7% to 32%), respectively. A history of cancer was more frequent in patients with poorer outcome.

    • orthotopic liver transplantation
    • chronic liver disease
    • infectious disease

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    https://bmj.com/coronavirus/usage
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    Footnotes

    • Twitter @mario.romero@salud.madrid.org, @dufour_jf

    • Correction notice This article has been corrected since it published Online First. The first affiliation has been amended.

    • Collaborators COVID-LT group: Michele Colledan (Department of Surgery, General Surgery and Abdominal Transplant Unit, "Papa Giovanni XXIII" Hospital, Bergamo, Italy), Stefano Fagiuoli (Gastroenterology and Transplant Hepatology, “Papa Giovanni XXIII” Hospital, Bergamo, Italy), Stefania Camagni (Gastroenterology and Transplant Hepatology, “Papa Giovanni XXIII” Hospital, Bergamo, Italy), Jean Delwaide (Division of Hepato-Gastroenterology and Digestive Oncology, University Hospital of Liege, Liege, Belgium), Giovanni Vitale (Department of Organ Failures and Transplantation, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy), Darius Moradpour (Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland), Manuel Pascual (Transplantation Center, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland), Gloria Allegrini (Department of Gastroenterology, University Hospital Ancona, Polytechnic University of Marche, Ancona, Italy), Fabio Tarsetti (Department of Gastroenterology, University Hospital Ancona, Polytechnic University of Marche, Ancona, Italy), Ugo Giustizieri (Department of Surgery, General Surgery and Abdominal Transplant Unit, "Papa Giovanni XXIII" Hospital, Bergamo, Italy), Loredana Rota (Gastroenterology and Transplant Hepatology, “Papa Giovanni XXIII” Hospital, Bergamo, Italy), Florent Artru (Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland), Anne-Catherine Saouli (Transplantation Center, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland), Patrizia Burra (Multivisceral Transplant Unit, Department of Surgery, Oncology, Gastroenterology, Padua University Hospital, Padua, Italy), Martina Gambato (Multivisceral Transplant Unit, Department of Surgery, Oncology, Gastroenterology, Padua University Hospital, Padua, Italy), Irene Scalera (Department of Hepato-Biliary Surgery and Liver Transplantation, “Cardarelli” Hospital of Naples, Naples, Italy), Ioannis Petridis (Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico - Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy), Hugo Pinto Marques (Hepato-Biliary-Pancreatic and Transplantation Center, Curry Cabral Hospital, Lisbon's Central Hospitals and University Center, NOVA Medical School, Lisboa, Portugal), Martin-Walter Welker(Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, Germany).

    • Contributors CB: study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, statistical analysis, administrative, technical and material support. MFZ, LP, MFD, FI, OD, GD, OC, MCM, MF, GS-B, HvV, MJC, MCR, AdG, PT: acquisition of data, critical revision of the manuscript regarding important intellectual content. LDP, CA: acquisition of data. DS, JP, FN: study concept and design, acquisition and interpretation of data, technical and material support, critical revision of the manuscript regarding important intellectual content. J-FD: study concept and design, interpretation of data, drafting of the manuscript, critical revision of the manuscript regarding important intellectual content, funding recipient, technical and material support, study supervision.

    • Funding This study was funded by Stiftung für die Leberkrankheiten (Switzerland).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval The ethical committee of each participating centre approved the study, which was carried in accordance with the Helsinki Declaration.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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