@article {Belligutjnl-2021-324879, author = {Luca Saverio Belli and Christophe Duvoux and Paolo Angelo Cortesi and Rita Facchetti and Speranta Iacob and Giovanni Perricone and Sylvie Radenne and Sara Conti and Damiano Patrono and Gabriela Berlakovich and Angus Hann and Luisa Pasulo and Lluis Castells and Francois Faitot and Olivier Detry and Federica Invernizzi and Giulia Magini and Paolo De Simone and Ilias Kounis and Maria Cristina Morelli and Fernando D{\'\i}az Fontenla and Bo-G{\"o}ran Ericzon and Carmelo Loinaz and Chris Johnston and Liliana Gheorghe and Mickael Lesurtel and Renato Romagnoli and Dagmar Kollmann and M Thamara PR Perera and Stefano Fagiuoli and Darius Mirza and Audrey Coilly and Christian Toso and Krzysztof Zieniewicz and Laure Elkrief and Vincent Karam and Rene Adam and Caroline den Hoed and Marco Merli and Massimo Puoti and Luciano De Carlis and Gabriel C Oniscu and Salvatore Piano and Paolo Angeli and Constantino Fondevila and Wojciech G Polak}, editor = {, and , and Vigan{\`o}, Raffaella and Mazzarelli, Chiara and Lauterio, Andrea and Giacomoni, Alessandro and Travi, Giovanna and Puoti, Massimo and Donato, Francesca and Lampertico, Pietro and Colledan, Michele and Zambelli, Marco and Guizzetti, Michela and Vitale, Giovanni and Benedetto, Fabrizio Di and Carrai, Paola and Petruccelli, Stefania and Incicco, Simone and Zen, Nicola and Michard, Baptiste and Faouzi, Saliba and Samiuel, Didier and Ngongang, Norbert and Poinsot, Domitille and Guichon, Celine and Gonzales, Emmanuel and Manaz, Derek and Colmenero, Jordi and Toapanta, David and Hidalgo, Ernest and Alamo, Jose Maria and Gomes, Esther Brea and Blanco, Gerardo and Marcacuzco, Alberto and Rodriguez, Gonzalo and Pascual, Sonia and Gy{\"o}ri, Georg and Pirenne, JAcques and Vandende, Natalie and Lucidi, Valerio and Magini, Giulia and Goossens, Nicolas and Jorns, Carl and Popescu, Irinel and Raszeja-Wyszomirska, Joanna}, title = {COVID-19 in liver transplant candidates: pretransplant and post-transplant outcomes - an ELITA/ELTR multicentre cohort study}, elocation-id = {gutjnl-2021-324879}, year = {2021}, doi = {10.1136/gutjnl-2021-324879}, publisher = {BMJ Publishing Group}, abstract = {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{\textendash}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{\textendash}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{\textendash}102) days, and 25 (96\%) were alive after a median follow-up of 118 days (IQR 31{\textendash}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\%).Data are available upon reasonable request. Contacts:Rita Facchetti, Rita.Facchetti@unimib.it; Paolo Cortesi, Paolo.cortesi@unimib.it; IDOTCOVID platform.}, issn = {0017-5749}, URL = {https://gut.bmj.com/content/early/2021/07/19/gutjnl-2021-324879}, eprint = {https://gut.bmj.com/content/early/2021/07/19/gutjnl-2021-324879.full.pdf}, journal = {Gut} }