Scientific publications

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. Scientific Publication

Mar 1, 2021 | Magazine: Gastroenterology

Luca S Belli  1 , Constantino Fondevila  2 , Paolo A Cortesi  3 , Sara Conti  3 , Vincent Karam  4 , Rene Adam  4 , Audrey Coilly  5 , Bo Goran Ericzon  6 , Carmelo Loinaz  7 , Valentin Cuervas-Mons  8 , Marco Zambelli  9 , Laura Llado  10 , Fernando Diaz-Fontenla  11 , Federica Invernizzi  12 , Damiano Patrono  13 , Francois Faitot  14 , Sherrie Bhooori  15 , Jacques Pirenne  16 , Giovanni Perricone  17 , Giulia Magini  18 , Lluis Castells  19 , Oliver Detry  20 , Pablo Mart Cruchaga  21 , Jordi Colmenero  2 , Frederick Berrevoet  22 , Gonzalo Rodriguez  23 , Dirk Ysebaert  24 , Sylvie Radenne  25 , Herold Metselaar  26 , Cristina Morelli  27 , Luciano G De Carlis  28 , Wojciech G Polak  29 , Christophe Duvoux  30 , ELITA-ELTR COVID-19 Registry


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 co-morbidities 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.

CITATION Gastroenterology. 2021 Mar;160(4):1151-1163.e3. doi: 10.1053/j.gastro.2020.11.045. Epub 2020 Dec 9.