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
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.
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