Clinical Characteristics and Outcomes of Liver Transplantation Recipients with COVID-19 Pneumonia

Kose, A; Toplu, SA; Yalcinsoy, M; Yakupogullari, Y; Otlu, B; Otan, E; Aydin, C; Yilmaz, S; Bayindir, Y

BACKGROUND: : We aimed to evaluate the clinical characteristics and outcomes of diagnosed with mild-severe COVID-19 pneumonia cases in liver transplantation (LT) recipients. MATERIAL AND METHODS: : Ten LT recipients diagnosed with COVID-19 pneumonia in six-month period in our transplantation center were included. Demographic and medical data of the recipients were retrospectively collected; clinical courses, treatment responses, and outcomes were evaluated. RESULTS: : Ten LT recipients were male, at median 57 years (min-max: 36-69; IQR: 13), and had right lobe, from living-donor LT performed in median eleven months (min-max: 1-72; IQR: 12). Five patients were diagnosed as severe, and the remaining were mild/moderate pneumonia. The most frequent symptoms were fever (90%) and cough (70%). Favipiravir, enoxaparin sodium and corticosteroid were initiated at the time of the diagnosis, immunosuppressive drug doses were reduced or discontinued in three cases. Lymphopenia median: 510/ml (min-max: 90-1400; IQR: 610), increased levels of CRP median: 4.72 (min-max:0.31-23.4; IQR: 8.5) and ferritin median: 641 (min-max:40-≥1650; IQR: 1108) were frequent. Four patients required antibacterial treatments due to emerging bacterial pneumonia and/or sepsis. All patients had a hospitalization for a median of ten days. One patient with sepsis died on the 26(th) day of intensive care unit (ICU) admission, and the remaining nine survived. No further complication was recorded for one-month follow-up. CONCLUSION: : The commencing of favipiravir, enoxaparin sodium and corticosteroid treatments, close follow-up of the developing complications, temporary reduction or cessation of immunosuppression, multidisciplinary approach, early awareness of the bacterial infections and the initiation appropriate antibiotic treatments can contribute to success.