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The impact of COVID-19 on liver transplantation programs in Austria
Lukas Hartl1,2, Elisabeth Tatscher3, Melanie Weiss1,2
1Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Insights
The number of liver transplants in Austria remained stable during COVID-19, but SARS-CoV-2 infections on the waiting list were rare and deadly. Vaccination rates were suboptimal, with a weaker immune response post-transplant.
Area of Science:
- Hepatology
- Transplantation Immunology
- Infectious Diseases
Background:
- The COVID-19 pandemic has impacted liver disease management globally.
- The specific effects on Austrian orthotopic liver transplantation (OLT) programs remain under-investigated.
Purpose of the Study:
- To analyze the impact of the COVID-19 pandemic on OLT programs in Austria.
- To assess SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infections, vaccination status, and outcomes in patients on the OLT waiting list.
Main Methods:
- Retrospective analysis of all patients listed for OLT in Austria between 2020-2021.
- Comparison of OLT numbers with pre-COVID-19 data (2015-2019).
- Evaluation of SARS-CoV-2 testing, infection rates, mortality, and vaccination data.
Main Results:
- 490 patients were listed for OLT; 61.2% underwent transplantation, and 8.8% died while awaiting OLT.
- The number of OLTs performed remained consistent with pre-pandemic levels.
- 7.7% of waiting list patients contracted COVID-19, with a 22.6% mortality rate among infected individuals.
- By end of 2021, 45.1% received two SARS-CoV-2 vaccinations; antibody response was weaker in patients vaccinated post-OLT.
Conclusions:
- Austrian OLT programs maintained transplant volumes during the COVID-19 pandemic.
- SARS-CoV-2 infection posed a significant mortality risk for patients on the OLT waiting list.
- Suboptimal vaccination rates and reduced immunogenicity post-OLT highlight the need for improved vaccination strategies.
Background:
Coronavirus disease of 2019 (COVID-19) has affected liver disease management. The impact of the COVID-19 pandemic on the Austrian orthotopic liver transplantation (OLT) programs, however, has not been systematically investigated.
Methods:
All patients listed for OLT in Austria during 2020-2021 were studied. Data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing, vaccinations, infections, mortality and the overall number of OLTs (vs. pre-COVID-19: 2015-2019) were analyzed.
Results:
Overall, 490 patients (median age: 58.0 years, 70.4% men, hepatocellular carcinoma: 27.3%) were listed for OLT in Austria in 2020-2021. Alcohol-related cirrhosis (35.3%), cholestatic (16.7%) and viral liver disease (13.9%) were the main etiologies. Of the patients 61.2% underwent OLT and 8.8% died while on the waiting list. The number of OLTs performed during COVID-19 (2020: n = 150; 2021: n = 150) remained unchanged compared to pre-COVID-19 (median: n = 152). Among waiting list patients, 7.7% (n = 31/401) were diagnosed with COVID-19 and 7 (22.6%) of these patients died. By the end of 2021, 45.1% (n = 176/390; 82.8% mRNA vaccinations) and 28.8% (105/365) of patients received 2 and 3 SARS-CoV‑2 vaccinations, respectively. After two SARS-CoV‑2 vaccinations, antibodies more often remained undetectable in patients vaccinated post-OLT (25.6% vs. 6.5% in patients vaccinated pre-OLT; p = 0.034). Patients with three vaccinations after OLT had lower antibody titers than patients vaccinated pre-OLT (post-OLT: 513.5, IQR 44.4-2500.0 vs. pre-OLT: 2500.0, IQR 1462.0-2500.0 BAU/mL; p = 0.020).
Conclusion:
The number of OLTs in Austria remained unchanged during COVID-19. SARS-CoV‑2 infections were rare but associated with high mortality in patients on the Austrian OLT waiting lists. SARS-CoV‑2 vaccination rates at the end of 2021 were suboptimal, while serological response was better in patients vaccinated pre-OLT vs. post-OLT.
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