Case Control Study
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World J Hepatol. Jun 27, 2022; 14(6): 1142-1149
Published online Jun 27, 2022. doi: 10.4254/wjh.v14.i6.1142
Clinical outcomes of coronavirus disease 2019 in liver transplant recipients
Muhammad Shafiq, Cheryl Gibson
Muhammad Shafiq, Cheryl Gibson, Department of General and Geriatric Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
Author contributions: Shafiq M was involved in all aspects of this study, including but not limited to study design, data collection, data analyses, and writing of the abstract and manuscript; Gibson C assisted with the study design and data analyses.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of University of Kansas Medical Center (Kansas City, KS, United States).
Informed consent statement: In accordance with the retrospective design of the study, based upon chart reviews, no informed consent was required.
Conflict-of-interest statement: All the authors have no conflicts of interest to declare.
Data sharing statement: All relevant data has been provided in this article. No additional data is available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Muhammad Shafiq, MD, Assistant Professor, Department of General and Geriatric Medicine, University of Kansas Medical Center, 4000 Cambridge Street, 6040 Delp & Mail Stop 1020, Kansas City, KS 66160, United States. mshafiq@kumc.edu
Received: January 5, 2022
Peer-review started: January 5, 2022
First decision: March 7, 2022
Revised: April 7, 2022
Accepted: May 28, 2022
Article in press: May 28, 2022
Published online: June 27, 2022
Processing time: 168 Days and 19.8 Hours
ARTICLE HIGHLIGHTS
Research background

Liver transplant patients are at higher risk of infection due to immunosuppression. Whether liver transplant recipients are also more susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and will have worse outcomes than the general population if they develop coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 is a topic of ongoing studies, including ours.

Research motivation

Liver transplant recipients require specialized care and timely access to health care. However, the data on outcomes of COVID-19 among liver transplant recipients besides hospitalization and mortality is limited. This led to our interest to explore additional outcomes of COVID-19 among liver transplant recipients.

Research objectives

The objective of the study was to assess clinical outcomes of COVID-19 in liver transplant recipients. Death and hospitalization due to COVID-19 were the primary outcomes. Secondary outcomes were pertinent only to patients who were hospitalized, and they included duration of hospital stay, need for supplemental oxygen, presence of at least one type of end-organ damage, effects on liver enzymes, incidence of acute liver failure, effect on d-dimer levels, and incidence of venous thromboembolism.

Research methods

This was a case-control study. Patients 18 years or older who tested positive for SARS-CoV-2 via polymerase chain reaction were included in the study. Patients with infection other than pneumonia at the time of admission were excluded. Patients who had been the recipient of liver transplant were considered cases and those without as controls. Chi-square or Fisher’s exact test was used to compare all primary and secondary outcomes with the exception of duration of hospital stay and d-dimer levels, which were compared using the Wilcoxon signed-rank test. Alpha criterion was set at 0.05. Statistical analyses were performed using R software.

Research results

There was no significant difference between cases and controls regarding death and hospitalization rates. There also was no significant difference between cases and controls with respect to all secondary outcomes.

Research conclusions

Clinical outcomes of COVID-19 in liver transplant recipients are not different than those without transplantation. COVID-19 should not impact timely health care access and immunosuppression continuation among these patients.

Research perspectives

Besides hospitalization and mortality, data on additional clinical outcomes of COVID-19 among liver transplant recipients is limited. Additional studies are needed to explore the full impact of COVID-19 among patients who have been the recipient of liver transplant.