Early Outcomes in Liver Transplant Recipients During Coronavirus Disease 2019 (COVID-19) Pandemic in the United States
Author Type(s)
Faculty
Document Type
Abstract
Publication Date
10-2021
DOI
10.1002/hep.32187 BUY
Journal Title
Hepatology
Department
Surgery
Second Department
Medicine
Abstract
Background: Uncertainties regarding management of SARS-CoV-2 infection and the diversion of significant health care resources toward COVID-19 in areas with very high disease activity resulted in hospitals curtailing transplant surgeries . The aim of this study was to analyze the effect of the COVID-19 pandemic on liver transplantation in United States. Methods: World Health Organization declared COVID-19 pandemic onMarch 11th in 2020. We retrospectively analyzed data from the United Network for Organ Sharing regarding outcomes in adult liver transplant recipients during COVID period (March 11- September 11, 2020) and compared them to pre-COVID period (March 11- September 11, 2019). COVID period also coincided with change in national liver organ allocation system from February 2020. Results: Overall, 4% fewer liver transplantation were done during the COVID period (4107 vs 4277) . This decrease was most pronounced in months of March-April 2020 with a rebound in numbers seen from May-July 2020. During the study period, the total number of liver transplantations performed decreased in regions 1, 2, 3, 5, 6, 8 with a paradoxical increase in regions 7, 9, 10 and 11. When compared to pre-COVID period; number of living donor liver transplants, median recipient age, recipient gender ratio and median body mass index remained same (p=NS). Alcoholic liver disease (32%) was the most common primary diagnosis during the COVID period with a significant increase (1315 vs 1187, p< 0.01) from pre-COVID period. During the COVID period, liver transplant recipients had higher median MELD (25 vs 23, p<0.01), lower waiting list time (52 vs 84 days, p<0.01), higher need for hemodialysis before transplant (457 vs 404, p= .012) and higher rate of multi-organ transplant (475 vs 402, p= 0.074). Donor age and gender ratio remained same (p=NS), but donor risk index was significantly higher in COVID period (1.65 vs 1.55, p<0.01). Distance between donor and recipient hospital was significantly higher in COVID era (131 vs 64, p<0.01). Graft survival and patient survival at 90-days post-transplantation was lower during the COVID period (94.5 vs 95.2 %: 96.0 vs 96.6 %, p<0.01). This difference was much more pronounced after 30 days post-transplantation . As programs attempted to pre-emptively lower overall immunosuppression during the COVID period, rejection episodes before discharge were higher (4.6% vs 3.4%, p=0.023). COVID-19 was the primary cause of death in 5/155 (3.2%) of total deaths in patients who were transplanted during the COVID period . In multivariable cox regression analysis for graft survival at 90 days, COVID period was one of the independent risk factors for graft failure (HR 1 .77, p<0.01). Conclusion: During the COVID period in United States, overall liver transplantation decreased, alcoholic liver disease was the primary diagnosis for liver transplantation, 90-day post-transplant graft survival was lower, and rate of organ rejection was higher
Recommended Citation
Okumura, K., Dhand, A., Sogawa, H., Butler, J., Veillette, G. R., John, D., Diflo, T., Bodin, R. I., Wolf, D. C., & Nishida, S. (2021). Early Outcomes in Liver Transplant Recipients During Coronavirus Disease 2019 (COVID-19) Pandemic in the United States. Hepatology, 74 (Suppl. 1), 9A-10A. https://doi.org/10.1002/hep.32187 BUY