Protective Role of Tacrolimus, Deleterious Role of Age and Comorbidities in Liver Transplant Recipients With Covid-19: Results From the ELITA/ELTR Multi-center European Study

Luca S. Belli*, Constantino Fondevila, ELITA-ELTR COVID-19 Registry, Paolo A. Cortesi, Sara Conti, Vincent Karam, Rene Adam, Audrey Coilly, Bo Goran Ericzon, Carmelo Loinaz, Valentin Cuervas-Mons, Marco Zambelli, Laura Llado, Fernando Diaz-Fontenla, Federica Invernizzi, Damiano Patrono, Francois Faitot, Sherrie Bhooori, Jacques Pirenne, Giovanni PerriconeGiulia Magini, Lluis Castells, Oliver Detry, Pablo Mart Cruchaga, Jordi Colmenero, Frederick Berrevoet, Gonzalo Rodriguez, Dirk Ysebaert, Sylvie Radenne, Herold Metselaar, Cristina Morelli, Luciano G. De Carlis, Wojciech G. Polak, Christophe Duvoux

*Corresponding author for this work

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Abstract

Background and Aims: Despite concerns that liver transplant (LT) recipients may be at increased risk of unfavorable outcomes from COVID-19 due the high prevalence of co-morbidities, immunosuppression and ageing, a detailed analysis of their effects in large studies is lacking. Methods: Data from adult LT recipients with laboratory confirmed SARS-CoV2 infection were collected across Europe. All consecutive patients with symptoms were included in the analysis. Results: Between March 1 and June 27, 2020, data from 243 adult symptomatic cases from 36 centers and 9 countries were collected. Thirty-nine (16%) were managed as outpatients while 204 (84%) required hospitalization including admission to the ICU (39 of 204, 19.1%). Forty-nine (20.2%) patients died after a median of 13.5 (10–23) days, respiratory failure was the major cause. After multivariable Cox regression analysis, age >70 (HR, 4.16; 95% CI, 1.78–9.73) had a negative effect and tacrolimus (TAC) use (HR, 0.55; 95% CI, 0.31–0.99) had a positive independent effect on survival. The role of co-morbidities was strongly influenced by the dominant effect of age where comorbidities increased with the increasing age of the recipients. In a second model excluding age, both diabetes (HR, 1.95; 95% CI, 1.06–3.58) and chronic kidney disease (HR, 1.97; 95% CI, 1.05–3.67) emerged as associated with death Conclusions: Twenty-five percent of patients requiring hospitalization for COVID-19 died, the risk being higher in patients older than 70 and with medical co-morbidities, such as impaired renal function and diabetes. Conversely, the use of TAC was associated with a better survival thus encouraging clinicians to keep TAC at the usual dose.

Original languageEnglish
Pages (from-to)1151-1163.e3
JournalGastroenterology
Volume160
Issue number4
DOIs
Publication statusPublished - 1 Mar 2021

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