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Title
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Protective role of tacrolimus, deleterious role of age and comorbidities in liver transplant recipients with Covid-19 : results from the ELITA/ELTR Multi-center European study
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Author
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Institution/Organisation
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ELITA-ELTR COVID-19 Registry
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Abstract
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| BACKGROUND AND AIMS: Despite concerns that liver transplant (LT) recipients may be at increased risk of unfavorable outcomes from COVID-19 due the high prevalence of co-morbidities, immunosuppression and ageing, a detailed analysis of their effects in large studies is lacking. METHODS: Data from adult LT recipients with laboratory confirmed SARS-CoV2 infection were collected across Europe. All consecutive patients with symptoms were included in the analysis. RESULTS: Between March 1 and June 27, 2020, data from 243 adult symptomatic cases from 36 centers and 9 countries were collected. Thirty-nine (16%) were managed as outpatients while 204 (84%) required hospitalization including admission to the ICU (39 of 204, 19.1%). Forty-nine (20.2%) patients died after a median of 13.5 (10-23) days, respiratory failure was the major cause. After multivariable Cox regression analysis, age >70 (HR, 4.16; 95% CI, 1.78-9.73) had a negative effect and tacrolimus (TAC) use (HR, 0.55; 95% CI, 0.31-0.99) had a positive independent effect on survival. The role of comorbidities was strongly influenced by the dominant effect of age where comorbidities increased with the increasing age of the recipients. In a second model excluding age, both diabetes (HR, 1.95; 95% CI, 1.06-3.58) and chronic kidney disease (HR, 1.97; 95% CI, 1.05-3.67) emerged as associated with death CONCLUSIONS: Twenty-five percent of patients requiring hospitalization for COVID-19 died, the risk being higher in patients older than 70 and with medical co-morbidities, such as impaired renal function and diabetes. Conversely, the use of TAC was associated with a better survival thus encouraging clinicians to keep TAC at the usual dose. |
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Language
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English
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Source (journal)
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Gastroenterology. - Baltimore, Md
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Publication
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Baltimore, Md
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2021
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ISSN
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0016-5085
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DOI
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10.1053/J.GASTRO.2020.11.045
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Volume/pages
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160
:4
(2021)
, p. 1151-1163
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ISI
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000627499000037
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Pubmed ID
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33307029
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Full text (Publisher's DOI)
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Full text (open access)
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