Liver Injury in Liver Transplant Recipients With Coronavirus Disease 2019 (COVID-19): U.S. Multicenter Experience

Atoosa Rabiee, Brett Sadowski, Nia Adeniji, Ponni V Perumalswami, Veronica Nguyen, Akshata Moghe, Nyan L Latt, Sonal Kumar, Costica Aloman, Andreea M Catana, Patricia P Bloom, Kenneth D Chavin, Rotonya M Carr, Winston Dunn, Vincent L Chen, Elizabeth S Aby, Jose D Debes, Renumathy Dhanasekaran, COLD Consortium, Donghee Kim, Marina Roytman, Kathleen Viveiros, Walter Chan, Michael Li, Alexander Vogel, Kara Wegerman, Tzu-Hao Lee, Kali Zhou, Atoosa Rabiee, Brett Sadowski, Nia Adeniji, Ponni V Perumalswami, Veronica Nguyen, Akshata Moghe, Nyan L Latt, Sonal Kumar, Costica Aloman, Andreea M Catana, Patricia P Bloom, Kenneth D Chavin, Rotonya M Carr, Winston Dunn, Vincent L Chen, Elizabeth S Aby, Jose D Debes, Renumathy Dhanasekaran, COLD Consortium, Donghee Kim, Marina Roytman, Kathleen Viveiros, Walter Chan, Michael Li, Alexander Vogel, Kara Wegerman, Tzu-Hao Lee, Kali Zhou

Abstract

Background and aims: Coronavirus disease 2019 (COVID-19) is associated with liver injury, but the prevalence and patterns of liver injury in liver transplantation (LT) recipients with COVID-19 are open for study.

Approach and results: We conducted a multicenter study in the United States of 112 adult LT recipients with COVID-19. Median age was 61 years (interquartile range, 20), 54.5% (n = 61) were male, and 39.3% (n = 44) Hispanic. Mortality rate was 22.3% (n = 25); 72.3% (n = 81) were hospitalized and 26.8% (n = 30) admitted to the intensive care unit (ICU). Analysis of peak values of alanine aminotransferase (ALT) during COVID-19 showed moderate liver injury (ALT 2-5× upper limit of normal [ULN]) in 22.2% (n = 18) and severe liver injury (ALT > 5× ULN) in 12.3% (n = 10). Compared to age- and sex-matched nontransplant patients with chronic liver disease and COVID-19 (n = 375), incidence of acute liver injury was lower in LT recipients (47.5% vs. 34.6%; P = 0.037). Variables associated with liver injury in LT recipients were younger age (P = 0.009; odds ratio [OR], 2.06; 95% confidence interval [CI], 1.20-3.54), Hispanic ethnicity (P = 0.011; OR, 6.01; 95% CI, 1.51-23.9), metabolic syndrome (P = 0.016; OR, 5.87; 95% CI, 1.38-24.99), vasopressor use (P = 0.018; OR, 7.34; 95% CI, 1.39-38.52), and antibiotic use (P = 0.046; OR, 6.93; 95% CI, 1.04-46.26). Reduction in immunosuppression (49.4%) was not associated with liver injury (P = 0.156) or mortality (P = 0.084). Liver injury during COVID-19 was significantly associated with mortality (P = 0.007; OR, 6.91; 95% CI, 1.68-28.48) and ICU admission (P = 0.007; OR, 7.93; 95% CI, 1.75-35.69) in LT recipients.

Conclusions: Liver injury is associated with higher mortality and ICU admission in LT recipients with COVID-19. Hence, monitoring liver enzymes closely can help in early identification of patients at risk for adverse outcomes. Reduction of immunosuppression during COVID-19 did not increase risk for mortality or graft failure.

© 2020 by the American Association for the Study of Liver Diseases.

Figures

FIG. 1
FIG. 1
Liver injury in LT recipients with COVID‐19. (A) Pattern of liver test elevations comparing baseline values with values at diagnosis of COVID‐19 and peak values during COVID‐19. (B) Predictors of liver injury in LT recipients with COVID‐19. (C) Risk for overall mortality in LT recipients with COVID‐19 with patients stratified by presence of liver injury. *P < 0.05; ***P < 0.001.

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