Liver Injury in Liver Transplant Recipients with Coronavirus Disease 2019 (COVID‐19): US Multicenter Experience

Rabiee, Atoosa; Sadowski, Brett; Adeniji, Nia; Perumalswami, Ponni; Nguyen, Veronica; Moghe, Akshata; Latt, Nyann; Kumar, Sonal; Aloman, Costica; Catana, Andreea M.; Bloom, Patricia P.; Chavin, Kenneth; Carr, Rotonya M.; Dunn, Winston; Chen, Vincent; Aby, Elizabeth S.; Debes, Jose; Dhanasekaran, Renumathy

BACKGROUND: Coronavirus disease 2019 (COVID‐19) is associated with liver injury, but the prevalence and patterns of liver injury in liver transplant (LT) recipients with COVID‐19 is not defined. APPROACH AND RESULTS: We conducted a multicenter study in the US of 112 adult LT recipients with COVID‐19. The median age was 61 years (IQR 20), 54.5% (n=61) were male, and 39.3% (n=44) Hispanic. The mortality rate was 22.3% (n=25); 72.3% (n=81) were hospitalized and 26.8% (n=30) admitted to the ICU. Analysis of peak values of alanine aminotransferase (ALT) during COVID‐19 showed moderate liver injury (ALT 2‐5x ULN) in 22.2% (n= 18) and severe liver injury (ALT > 5x ULN) in 12.3% (n= 10). Compared to age and gender matched non‐transplant patients with CLD and COVID‐19 (n=375), the 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 [1.20‐3.54]), Hispanic ethnicity (p= 0.011; OR 6.01 [1.51‐23.9]), metabolic syndrome (p= 0.016; OR 5.87 [1.38‐24.99]), vasopressor use (p= 0.018; OR 7.34 [1.39‐38.52]) and antibiotic use (p= 0.046; OR 6.93 [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[1.75‐35.69]) in LT recipients. CONCLUSION: 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.