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Published on: November 7, 2020
The impact of COVID-19 on liver transplantation: challenges and perspectives
1Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO, USA.
Insights
The COVID-19 pandemic initially disrupted liver transplants (LTs), increasing waitlist mortality. However, transplant centers adapted, and LT patients with COVID-19 did not face higher mortality risks than non-LT patients.
Area of Science:
- Hepatology
- Infectious Diseases
- Transplant Surgery
Background:
- The COVID-19 pandemic created significant challenges for patients with decompensated cirrhosis awaiting liver transplantation (LT).
- Access to medical facilities for routine care and organ procurement was initially disrupted, leading to decreased LTs and increased waitlist mortality.
- Immunosuppressed LT patients faced heightened infection risks.
Purpose of the Study:
- To analyze the impact of the COVID-19 pandemic on liver transplantation (LT) and outcomes for LT patients infected with the virus.
- To assess mortality risks and factors associated with COVID-19 in liver transplant recipients.
- To review the safety and efficacy of COVID-19 vaccines in LT patients.
Main Methods:
- Review of pandemic-related disruptions to LT access and organ procurement.
- Analysis of COVID-19 outcomes in liver transplant recipients compared to non-LT patients.
- Evaluation of mortality risk factors and vaccine immunogenicity in LT populations.
Main Results:
- Initial pandemic phase saw reduced LTs and increased waitlist mortality, but numbers later recovered due to center adaptability.
- Liver transplantation itself was not a risk factor for COVID-19 mortality; common risk factors included age, hypertension, diabetes, obesity, and kidney disease.
- Respiratory complications were the primary cause of death; liver-related deaths were infrequent (1.6%).
- COVID-19 vaccines were found to be safe and well-tolerated in LT patients, despite some concerns about immunogenicity.
Conclusions:
- Liver transplant centers demonstrated resilience and adaptability during the COVID-19 pandemic, restoring LT volumes.
- Liver transplant recipients infected with COVID-19 did not experience increased mortality compared to the general population, with traditional comorbidities being key risk factors.
- COVID-19 vaccines are safe for LT patients, and further research is needed on COVID-19's long-term effects like cholangiopathy.
Abstract:
The coronavirus disease 2019 (COVID-19) pandemic presented unique challenges to patients with decompensated cirrhosis awaiting transplant, with respect to accessing medical facilities for routine clinic visits, imaging, laboratory workup, or endoscopies. There was a delay in organ procurement that led to a decrease in the number of liver transplants (LTs) and an increase in the morality of waitlisted patients at the beginning of the pandemic. LT numbers later equalized to pre-pandemic numbers due to combined efforts and adaptability of transplant centers as well as dynamic guidelines. Due to being immunosuppressed, the demographics of LT patients were at an increased risk of infection. Although there is a higher rate of mortality and morbidity in patients with chronic liver disease, LT itself is not a risk factor for mortality in COVID-19. There was no difference in overall mortality in LT patients compared to non-LT patients, and mortality risk factors were the same: age, hypertension, diabetes, obesity, and chronic kidney disease. The most common causes of death were respiratory complications. Liver-related deaths were reported in 1.6% of patients. The optimal timing of liver transplantation post-infection depends on various factors, such as the severity of liver injury, the presence of comorbidities, and the progression of the underlying liver disease. There is not enough data available on COVID-19 cholangiopathy and the number of cases that will be seen in the future that will require LT. There are some concerns of lower immunogenicity of COVID-19 vaccines in LT patients but available evidence suggests that the vaccines are safe and well-tolerated.
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