Jamir Imtiakum, Kumar Niteen, Sood Gaurav, George Ashish, Lohia Pankaj, Pasupuleti Samba Siva Rao, Sahney Amrish, Wadhawan Manav, Kumar Ajay, Chaudhary Abhideep
Department of HPB Surgery and Liver Transplantation, BLK Super Speciality Hospital, New Delhi, India.
Department of Critical Care, BLK Super Speciality Hospital, New Delhi, India.
J Clin Transl Hepatol. 2022 Aug 28;10(4):770-777. doi: 10.14218/JCTH.2021.00303. Epub 2021 Oct 12.
The anticipated fear of serious outcomes in coronavirus infected liver transplant recipients led to disruption of transplant services globally. The aim of our study was to analyze COVID-19 severity in transplant recipients and to compare the difference of COVID-19 clinical outcomes in early (<1 year) vs. late (>1 year) post-transplant period.
41 post-living donor liver transplant recipients with COVID-19 infection were studied retrospectively from 1st April 2020 to 28th February 2021.
The median age was 49.00 years with a male preponderance (80.49%). Fifteen patients had infection within 1 year of transplant and 26 were infected after 1 year of transplant. The overall median interval between transplantation and COVID-19 diagnosis was 816.00 days. Fever and malaise were the common presenting symptoms. The most common associated comorbidities were diabetes mellitus (65.85%) and hypertension (46.34%). The severity of illness was mild in 28 (68.29%), moderate in 4 (9.76%), severe in 6 (14.63%) and critical in 3 (7.32%). To identify associated risk factors, we divided our patients into less severe and more severe groups. Except for lymphopenia, there was no worsening of total bilirubin, transaminases, alkaline phosphatase, and gamma-glutamyl transferase in the more severe group. Eight (19.51%) patients required intensive care unit admission and three (7.32%) died, while none suffered graft rejection. In recipients with early vs. late post-transplant COVID-19 infection, there were similar outcomes in terms of severity of COVID-19 illness, intensive care unit care need, requirement of respiratory support, and death.
Living donor liver transplantation can be performed during the COVID-19 pandemic without the fear of poor recipient outcome in cases of unfortunate contraction of severe acute respiratory syndrome coronavirus-2.
对冠状病毒感染的肝移植受者严重后果的预期恐惧导致全球移植服务中断。我们研究的目的是分析移植受者中新冠病毒疾病（COVID-19）的严重程度，并比较移植后早期（<1年）与晚期（>1年）COVID-19临床结局的差异。
回顾性研究了2020年4月1日至2021年2月28日期间41例接受活体供肝移植且感染COVID-19的受者。
中位年龄为49.00岁，男性占多数（80.49%）。15例患者在移植后1年内感染，26例在移植后1年以上感染。移植与COVID-19诊断之间的总体中位间隔为816.00天。发热和乏力是常见的症状。最常见的合并症是糖尿病（65.85%）和高血压（46.34%）。28例（68.29%）病情为轻度，4例（9.76%）为中度，6例（14.63%）为重度，3例（7.32%）为危重度。为了确定相关危险因素，我们将患者分为病情较轻组和病情较重组。除淋巴细胞减少外，病情较重组的总胆红素、转氨酶、碱性磷酸酶和γ-谷氨酰转移酶均无恶化。8例（19.51%）患者需要入住重症监护病房，3例（7.32%）死亡，无一例发生移植物排斥反应。在移植后早期与晚期感染COVID-19的受者中，COVID-19疾病严重程度、重症监护需求、呼吸支持需求和死亡方面的结局相似。
在COVID-19大流行期间可以进行活体供肝移植，不用担心在不幸感染严重急性呼吸综合征冠状病毒2的情况下受者预后不良。
