The Impact of Covid-19 across centres affiliated with the European Liver Transplant Registry: A 3-part study
Author: Vincent Karam, ESOT Registries General Manager
ELITA, which is the ESOT section dedicated to liver transplantation, has conducted several studies on COVID-19.
Data on the impact of the COVID-19 pandemic on liver transplantation (LT) in Europe were limited when a three-part study was conducted among centres affiliated with the European Liver Transplant Registry (ELTR).
The first part, an internet survey, was the first large-scale European snapshot study that clearly showed that transplant candidates and liver transplant recipients were at high risk of COVID-19. These results argued for early and proactive screening for COVID-19 symptoms in these populations. [1, 2]
The second part, which focused on identifying risk factors associated with mortality in liver transplant patients who contracted COVID-19, showed that 25% of patients who required hospitalisation for COVID-19 died, with a higher risk in patients over 70 years of age and with medical co-morbidities, such as impaired renal function and diabetes. Conversely, the use of tacrolimus (TAC) as immunosuppressive therapy was associated with better survival, encouraging clinicians to maintain TAC at the usual dose. [3]
The third part, which explored the impact of COVID-19 on patients on the LT waiting list (LT candidates) and their post-LT course, showed a high risk of mortality in these patients (32.7%), reaching 45% in some conditions, with no significant difference between the first and second wave of the pandemic. Respiratory failure was the leading cause of death. The poor prognosis of patients with decompensated cirrhosis argued for strict preventive measures and urgent verification of the effectiveness of vaccination in this population. Prior symptomatic infection with SARS-CoV-2 did not affect early post-transplant survival. [4]
References
1. Belli, Luca S, et al. “COVID-19 in Liver Transplant Recipients: Preliminary Data from the ELITA/ELTR Registry.” The Lancet Gastroenterology & Hepatology, vol. 5, no. 8, Aug. 2020, pp. 724–25. DOI.org (Crossref), https://doi.org/10.1016/S2468-1253(20)30183-7.
2. Polak, Wojciech G., et al. “Impact of COVID‐19 on Liver Transplantation in Europe: Alert from an Early Survey of European Liver and Intestine Transplantation Association and European Liver Transplant Registry.” Transplant International, vol. 33, no. 10, Oct. 2020, pp. 1244–52. DOI.org (Crossref), https://doi.org/10.1111/tri.13680.
3. Belli, Luca S., et al. “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.” Gastroenterology, vol. 160, no. 4, Mar. 2021, pp. 1151-1163.e3. DOI.org (Crossref), https://doi.org/10.1053/j.gastro.2020.11.045.
4. Belli, Luca Saverio, et al. “COVID-19 in Liver Transplant Candidates: Pretransplant and Post-Transplant Outcomes - an ELITA/ELTR Multicentre Cohort Study.” Gut, vol. 70, no. 10, Oct. 2021, pp. 1914–24. DOI.org (Crossref), https://doi.org/10.1136/gutjnl-2021-324879.
