Diagnosis, treatment protocols, and outcomes of liver transplant recipients infected with COVID-19

Abstract

Several cases of fatal pneumonia during November 2019 were linked initially to severe acute respiratory syndrome coronavirus 2, which the World Health Organization later designated as coronavirus disease 2019 (COVID-19). The World Health Organization declared COVID-19 as a pandemic on March 11, 2020. In the general population, COVID-19 severity can range from asymptomatic/mild symptoms to seriously ill. Its mortality rate could be as high as 49%. The Centers for Disease Control and Prevention have acknowledged that people with specific underlying medical conditions, among those who need immunosuppression after solid organ transplantation (SOT), are at an increased risk of developing severe illness from COVID-19. Liver transplantation is the second most prevalent SOT globally. Due to their immunosuppressed state, liver transplant (LT) recipients are more susceptible to serious infections. Therefore, comorbidities and prolonged immunosuppression among SOT recipients enhance the likelihood of severe COVID-19. It is crucial to comprehend the clinical picture, immunosuppressive management, prognosis, and prophylaxis of COVID-19 infection because it may pose a danger to transplant recipients. This review described the clinical and laboratory findings of COVID-19 in LT recipients and the risk factors for severe disease in this population group. In the following sections, we discussed current COVID-19 therapy choices, reviewed standard practice in modifying immunosuppressant regimens, and outlined the safety and efficacy of currently licensed drugs for inpatient and outpatient management. Additionally, we explored the clinical outcomes of COVID-19 in LT recipients and mentioned the efficacy and safety of vaccination use.

Keywords: COVID-19; Liver transplantation; Recipient; Protocols; Outcomes

Core Tip: Liver transplant (LT) patients infected with severe acute respiratory syndrome coronavirus 2 have clinical, biochemical, and radiological features highly comparable to those of immunocompetent patients, except for a higher incidence of gastrointestinal symptoms. The prognosis of LT recipients is similar to non-LT patients and is not significantly affected by immunosuppression but rather by comorbidities. Considering the risk of organ rejection, it may not be wise to stop all immunosuppression after a coronavirus disease 2019 diagnosis. All LT recipients should be vaccinated, considering booster doses augment vaccination immunogenicity. Still, a considerable proportion of patients remain at risk for coronavirus disease 2019. Therefore, social isolation and other precautions must be maintained.