Division of Gastroenterology, VA Medical Center, Washington, DC.
Division of Gastroenterology, Georgetown University, Washington, DC.
Hepatology. 2020 Dec;72(6):1900-1911. doi: 10.1002/hep.31574. Epub 2020 Dec 9.
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.
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.
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.
COVID-19 与肝损伤有关，但 COVID-19 肝移植（LT）受者肝损伤的流行率和模式仍有待研究。
我们在美国进行了一项多中心研究，纳入了 112 例 COVID-19 成年 LT 受者。中位年龄为 61 岁（四分位距 20），54.5%（n=61）为男性，39.3%（n=44）为西班牙裔。死亡率为 22.3%（n=25）；72.3%（n=81）住院，26.8%（n=30）入住重症监护病房（ICU）。分析 COVID-19 期间丙氨酸氨基转移酶（ALT）峰值发现，22.2%（n=18）为中度肝损伤（ALT 2-5×正常值上限[ULN]），12.3%（n=10）为重度肝损伤（ALT>5×ULN）。与年龄和性别匹配的 COVID-19 慢性肝病非移植患者（n=375）相比，LT 受者的急性肝损伤发生率较低（47.5%比 34.6%；P=0.037）。与 LT 受者肝损伤相关的变量包括年龄较小（P=0.009；比值比[OR]，2.06；95%置信区间[CI]，1.20-3.54）、西班牙裔（P=0.011；OR，6.01；95% CI，1.51-23.9）、代谢综合征（P=0.016；OR，5.87；95% CI，1.38-24.99）、血管加压药使用（P=0.018；OR，7.34；95% CI，1.39-38.52）和抗生素使用（P=0.046；OR，6.93；95% CI，1.04-46.26）。减少免疫抑制（49.4%）与肝损伤（P=0.156）或死亡率（P=0.084）无关。COVID-19 期间的肝损伤与 LT 受者的死亡率（P=0.007；OR，6.91；95% CI，1.68-28.48）和 ICU 入院（P=0.007；OR，7.93；95% CI，1.75-35.69）显著相关。
COVID-19 肝移植受者的肝损伤与更高的死亡率和 ICU 入院率相关。因此，密切监测肝酶有助于早期识别有不良预后风险的患者。COVID-19 期间减少免疫抑制并不会增加死亡率或移植物失功的风险。
