tetano
Editor, Senior Moderator
J Hepatol
. 2020 Aug 1;S0168-8278(20)30521-3.
doi: 10.1016/j.jhep.2020.07.040. Online ahead of print.
Epidemiological pattern, incidence and outcomes of COVID-19 in liver transplant patients
Jordi Colmenero[SUP] 1 [/SUP], Manuel Rodr?guez-Per?lvarez[SUP] 2 [/SUP], Magdalena Salcedo[SUP] 3 [/SUP], Ana Arias-Milla[SUP] 4 [/SUP], Alejandro Mu?oz-Serrano[SUP] 4 [/SUP], Javier Graus[SUP] 5 [/SUP], Javier Nu?o[SUP] 6 [/SUP], Mikel Gastaca[SUP] 7 [/SUP], Javier Bustamante-Schneider[SUP] 7 [/SUP], Alba Cachero[SUP] 8 [/SUP], Laura Llad?[SUP] 8 [/SUP], Ar?nzazu Caballero[SUP] 3 [/SUP], Ainhoa Fern?ndez-Yunquera[SUP] 3 [/SUP], Carmelo Loinaz[SUP] 9 [/SUP], Inmaculada Fern?ndez[SUP] 9 [/SUP], Constantino Fondevilla[SUP] 10 [/SUP], Miquel Navasa[SUP] 1 [/SUP], Mercedes I?arrairaegui[SUP] 11 [/SUP], Lluis Castells[SUP] 12 [/SUP], Sonia Pascual[SUP] 13 [/SUP], Pablo Ram?rez[SUP] 14 [/SUP], Carmen Vinaixa[SUP] 15 [/SUP], Mar?a Luisa Gonz?lez-Dieguez[SUP] 16 [/SUP], Roc?o Gonz?lez-Grande[SUP] 17 [/SUP], Loreto Hierro[SUP] 18 [/SUP], Flor Nogueras[SUP] 19 [/SUP], Alejandra Otero[SUP] 20 [/SUP], Jos? Mar?a ?lamo[SUP] 21 [/SUP], Gerardo Blanco-Fern?ndez[SUP] 22 [/SUP], Emilio F?brega[SUP] 23 [/SUP], Fernando Garc?a-Pajares[SUP] 24 [/SUP], Jos? Luis Montero[SUP] 25 [/SUP], Santiago Tom?[SUP] 26 [/SUP], Gloria De la Rosa[SUP] 27 [/SUP], Jos? Antonio Pons[SUP] 28 [/SUP]
Affiliations
Abstract
Background & aims: The incidence and outcomes of coronavirus disease 2019 (Covid-19) in immunocompromised patients are a matter of debate.
Methods: Prospective nationwide study including a consecutive cohort of liver transplant patients with Covid-19 recruited during the Spanish outbreak from February 28[SUP]th[/SUP] to April 7[SUP]th[/SUP], 2020. The primary outcome was severe Covid-19, defined as the need for mechanical ventilation, intensive care, and/or death. Age- and gender-standardized incidence and mortality ratios (SIR and SMR) were calculated using data from the Ministry of Health and the Spanish liver transplant registry. Independent predictors of severe Covid-19 among hospitalized patients were analyzed using multivariate Cox regression.
Results: A total of 111 liver transplant patients were diagnosed with Covid-19 (SIR=191.2 [95%CI 190.3-192.2]). The epidemiological curve and geographic distribution overlapped widely between liver transplant and general populations. After a median follow-up of 23 days, 96 patients (86.5%) were admitted to hospital and 22 patients (19.8%) required respiratory support. Twelve patients were admitted to the ICU (10.8%). The mortality rate was 18%, being lower compared to the matched general population (SMR=95.5 [95%CI 94.2-96.8]). Thirty-five patients (31.5%) met criteria of severe Covid-19. Baseline immunosuppression containing mycophenolate was an independent predictor of severe Covid-19 (RR=3.94; 95%CI 1.59-9.74; p=0.003), particularly at doses higher than 1,000 mg/day (p=0.003). This deleterious effect was not observed with calcineurin inhibitors or everolimus and complete immunosuppression withdrawal showed no benefit.
Conclusions: Being chronically immunosuppressed, liver transplant patients have an increased risk of acquiring Covid-19 but their mortality rates are lower than matched general population. Upon hospital admission, mycophenolate dose reduction or withdrawal could help in preventing severe Covid-19. However, complete immunosuppression withdrawal should be discouraged.
Keywords: Covid-19; SARS-CoV-2; calcineurin inhibitors; epidemiology; everolimus; immunosuppression; mycophenolate; pneumonia; standardized incidence; standardized mortality; tacrolimus; transplantation.
. 2020 Aug 1;S0168-8278(20)30521-3.
doi: 10.1016/j.jhep.2020.07.040. Online ahead of print.
Epidemiological pattern, incidence and outcomes of COVID-19 in liver transplant patients
Jordi Colmenero[SUP] 1 [/SUP], Manuel Rodr?guez-Per?lvarez[SUP] 2 [/SUP], Magdalena Salcedo[SUP] 3 [/SUP], Ana Arias-Milla[SUP] 4 [/SUP], Alejandro Mu?oz-Serrano[SUP] 4 [/SUP], Javier Graus[SUP] 5 [/SUP], Javier Nu?o[SUP] 6 [/SUP], Mikel Gastaca[SUP] 7 [/SUP], Javier Bustamante-Schneider[SUP] 7 [/SUP], Alba Cachero[SUP] 8 [/SUP], Laura Llad?[SUP] 8 [/SUP], Ar?nzazu Caballero[SUP] 3 [/SUP], Ainhoa Fern?ndez-Yunquera[SUP] 3 [/SUP], Carmelo Loinaz[SUP] 9 [/SUP], Inmaculada Fern?ndez[SUP] 9 [/SUP], Constantino Fondevilla[SUP] 10 [/SUP], Miquel Navasa[SUP] 1 [/SUP], Mercedes I?arrairaegui[SUP] 11 [/SUP], Lluis Castells[SUP] 12 [/SUP], Sonia Pascual[SUP] 13 [/SUP], Pablo Ram?rez[SUP] 14 [/SUP], Carmen Vinaixa[SUP] 15 [/SUP], Mar?a Luisa Gonz?lez-Dieguez[SUP] 16 [/SUP], Roc?o Gonz?lez-Grande[SUP] 17 [/SUP], Loreto Hierro[SUP] 18 [/SUP], Flor Nogueras[SUP] 19 [/SUP], Alejandra Otero[SUP] 20 [/SUP], Jos? Mar?a ?lamo[SUP] 21 [/SUP], Gerardo Blanco-Fern?ndez[SUP] 22 [/SUP], Emilio F?brega[SUP] 23 [/SUP], Fernando Garc?a-Pajares[SUP] 24 [/SUP], Jos? Luis Montero[SUP] 25 [/SUP], Santiago Tom?[SUP] 26 [/SUP], Gloria De la Rosa[SUP] 27 [/SUP], Jos? Antonio Pons[SUP] 28 [/SUP]
Affiliations
- PMID: 32750442
- PMCID: PMC7395653
- DOI: 10.1016/j.jhep.2020.07.040
Abstract
Background & aims: The incidence and outcomes of coronavirus disease 2019 (Covid-19) in immunocompromised patients are a matter of debate.
Methods: Prospective nationwide study including a consecutive cohort of liver transplant patients with Covid-19 recruited during the Spanish outbreak from February 28[SUP]th[/SUP] to April 7[SUP]th[/SUP], 2020. The primary outcome was severe Covid-19, defined as the need for mechanical ventilation, intensive care, and/or death. Age- and gender-standardized incidence and mortality ratios (SIR and SMR) were calculated using data from the Ministry of Health and the Spanish liver transplant registry. Independent predictors of severe Covid-19 among hospitalized patients were analyzed using multivariate Cox regression.
Results: A total of 111 liver transplant patients were diagnosed with Covid-19 (SIR=191.2 [95%CI 190.3-192.2]). The epidemiological curve and geographic distribution overlapped widely between liver transplant and general populations. After a median follow-up of 23 days, 96 patients (86.5%) were admitted to hospital and 22 patients (19.8%) required respiratory support. Twelve patients were admitted to the ICU (10.8%). The mortality rate was 18%, being lower compared to the matched general population (SMR=95.5 [95%CI 94.2-96.8]). Thirty-five patients (31.5%) met criteria of severe Covid-19. Baseline immunosuppression containing mycophenolate was an independent predictor of severe Covid-19 (RR=3.94; 95%CI 1.59-9.74; p=0.003), particularly at doses higher than 1,000 mg/day (p=0.003). This deleterious effect was not observed with calcineurin inhibitors or everolimus and complete immunosuppression withdrawal showed no benefit.
Conclusions: Being chronically immunosuppressed, liver transplant patients have an increased risk of acquiring Covid-19 but their mortality rates are lower than matched general population. Upon hospital admission, mycophenolate dose reduction or withdrawal could help in preventing severe Covid-19. However, complete immunosuppression withdrawal should be discouraged.
Keywords: Covid-19; SARS-CoV-2; calcineurin inhibitors; epidemiology; everolimus; immunosuppression; mycophenolate; pneumonia; standardized incidence; standardized mortality; tacrolimus; transplantation.