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Review
. 2021 Jul-Sep:3:100026.
doi: 10.1016/j.liver.2021.100026. Epub 2021 Jul 22.

COVID-19 in liver transplant recipients

Juliana Piedade  1   2   3 , Gustavo Pereira  1   2   3
Affiliations
Review

COVID-19 in liver transplant recipients

Juliana Piedade et al. J Liver Transpl. 2021 Jul-Sep.

Abstract

Coronavirus disease 2019 (COVID-19), an infection caused by severe acute respiratory syndrome coronavirus-type 2 (SARS-CoV-2), has emerged as a serious threat to public health. Liver transplant (LT) recipients may be at increased risk of acquisition of SARS-CoV-2 infection and higher morbidity and mortality due to constant contact with health-care services, the use of immunosuppressants and frequent comorbidities. In the first part of this review we discuss (1) the epidemiology and risk factors for SARS-CoV-2 infection in LT recipients; (2) the clinical and laboratory features of COVID-19 in this specific population, highlighting differences in presenting signs and symptoms with respect to general populations and (3) the natural history and prognostic factors in LT recipients hospitalized with COVID-19, with particular focus on the possible role of immunosuppression. Thereafter, we review the potential therapeutic options for COVID-19 treatment and prevention. Specifically, we give an overview of current practice in immunosuppressant regimen changes, showing the potential benefits of this strategy, and explore safety and efficacy issues of currently approved drugs in LT recipients. The last topic is dedicated to the potential benefits and pitfalls of vaccination.

Keywords: ACE2, angiotensin-converting; CI, calcineurin inhibitors; CI, confidence interval; COVID-19; COVID-19 drug treatment; DILI, drug-induced liver injury; ECMO, extracorporeal membrane oxygenation; GI, gastrointestinal; HR, hazard ratio; ICU, intensive care unit; IL-6, interleukin-6; IS, immunosuppression; Immunosuppressive agents; LT, liver transplant; Liver transplantation; MELD, Model for End-Stage Liver Disease; MMF, mycophenolate mofetil; OR, odds ratio; RCT, randomized controlled trial; SARS-CoV2, severe acute respiratory syndrome coronavirus 2; SOT, solid organ transplant; ULN, upper limits of normal; Vaccination; WHO, World Health Organization.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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