COVID-19 and Short- and Medium-term Outcomes in Liver Transplant Patients: A Spanish Single-center Case Series

Abstract

Background & aims: The evidence suggests that most vulnerable subjects to COVID-19 infection suffer from patients with comorbidities or immunosuppression, including liver transplant recipients. Liver graft dysfunction may be a rare complication. Some patients complain about the post-COVID-19 syndrome. The aim of this study was to assess medium- and short-term outcomes in liver transplant patients.

Patients and methods: A retrospective case series was performed at a tertiary referral center. We screened 845 patients who had liver transplant (LT) in our center. All consecutive LT patients with COVID-19 during the Spanish outbreak from March 2020 to April 2021 were included. Demographics, pre-existing comorbidities, clinical and radiological data of COVID-19 infection, complications, and liver graft function were assessed at diagnosis and 3-month follow-up.

Results: Overall, 20 LT patients were diagnosed with confirmed COVID-19. We included 16 patients that met the inclusion criteria, 8 nonhospitalized (50%) and 8 (50%) hospitalized patients were analyzed. The median follow-up was 5.33 months (IQR 3.06-8.26). One patient died during the follow-up. All patients presented some grade of respiratory or functional symptoms. Dyspnea and fatigue were the most prevalent symptoms during the 3-month follow-up. No liver graft dysfunction were reported despite of partial immunosuppression withdrawal in four patients (25%). One patient had cardiovascular complications.

Conclusions: Our results suggest the presence of post-COVID-19 syndrome with mild residual physical and psychological dysfunction in this subgroup of patients at 3 months after COVID-19. However, no cases of loss or liver graft dysfunction were reported.

Keywords: CNI, Calcineurin inhibitors; COVID-19; COVID-19, Coronavirus disease 2019; LT, Liver transplantation; RT-PCR, reverse transcriptase polymerase chain reaction; SARS-CoV-2; SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2; SD, standard deviation; STAI, State Trait Anxiety Inventory; WHIIRS, Women's Health Initiative Insomnia Rating Scale; WHOQOL, World Health Organization quality of life; immunosuppression; liver transplantation; m-TOR, Mammalian Target of Rapamycin; sequelae.