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

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

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