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Liver Injury in Liver Transplant Recipients With Coronavirus Disease 2019 (COVID‐19): U.S. Multicenter Experience
Author(s) -
Rabiee Atoosa,
Sadowski Brett,
Adeniji Nia,
Perumalswami Ponni V.,
Nguyen Veronica,
Moghe Akshata,
Latt Nyan L.,
Kumar Sonal,
Aloman Costica,
Catana Andreea M.,
Bloom Patricia P.,
Chavin Kenneth D.,
Carr Rotonya M.,
Dunn Winston,
Chen Vincent L.,
Aby Elizabeth S.,
Debes Jose D.,
Dhanasekaran Renumathy
Publication year - 2020
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.31574
Subject(s) - medicine , interquartile range , liver transplantation , gastroenterology , odds ratio , liver injury , confidence interval , liver disease , intensive care unit , incidence (geometry) , transplantation , physics , optics
Background and Aims Coronavirus disease 2019 (COVID‐19) is associated with liver injury, but the prevalence and patterns of liver injury in liver transplantation (LT) recipients with COVID‐19 are open for study. Approach and Results We conducted a multicenter study in the United States of 112 adult LT recipients with COVID‐19. Median age was 61 years (interquartile range, 20), 54.5% (n = 61) were male, and 39.3% (n = 44) Hispanic. Mortality rate was 22.3% (n = 25); 72.3% (n = 81) were hospitalized and 26.8% (n = 30) admitted to the intensive care unit (ICU). Analysis of peak values of alanine aminotransferase (ALT) during COVID‐19 showed moderate liver injury (ALT 2‐5× upper limit of normal [ULN]) in 22.2% (n = 18) and severe liver injury (ALT > 5× ULN) in 12.3% (n = 10). Compared to age‐ and sex‐matched nontransplant patients with chronic liver disease and COVID‐19 (n = 375), incidence of acute liver injury was lower in LT recipients (47.5% vs. 34.6%; P = 0.037). Variables associated with liver injury in LT recipients were younger age ( P = 0.009; odds ratio [OR], 2.06; 95% confidence interval [CI], 1.20‐3.54), Hispanic ethnicity ( P = 0.011; OR, 6.01; 95% CI, 1.51‐23.9), metabolic syndrome ( P = 0.016; OR, 5.87; 95% CI, 1.38‐24.99), vasopressor use ( P = 0.018; OR, 7.34; 95% CI, 1.39‐38.52), and antibiotic use ( P = 0.046; OR, 6.93; 95% CI, 1.04‐46.26). Reduction in immunosuppression (49.4%) was not associated with liver injury ( P = 0.156) or mortality ( P = 0.084). Liver injury during COVID‐19 was significantly associated with mortality ( P = 0.007; OR, 6.91; 95% CI, 1.68‐28.48) and ICU admission ( P = 0.007; OR, 7.93; 95% CI, 1.75‐35.69) in LT recipients. Conclusions Liver injury is associated with higher mortality and ICU admission in LT recipients with COVID‐19. Hence, monitoring liver enzymes closely can help in early identification of patients at risk for adverse outcomes. Reduction of immunosuppression during COVID‐19 did not increase risk for mortality or graft failure.