Varied clinical presentation and outcome of SARS‐CoV‐2 infection in liver transplant recipients: initial experience at a single center in Madrid, Spain

Loinaz, Carmelo; Marcacuzco, Alberto; Fernández‐Ruiz, Mario; Caso, Oscar; Cambra, Félix; San Juan, Rafael; Justo, Iago; Calvo, Jorge; García‐Sesma, Alvaro; Manrique, Alejandro; Pérez‐Jacoiste Asín, María Asunción; Folgueira, María Dolores; Aguado, José María; Lumbreras, Carlos

BACKGROUND: Which are the consequences of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV2) infection in liver transplant (LT) recipients? METHODS: We attempted to address this question by reviewing our single‐center experience during the first two months of the pandemics at a high incidence area. RESULTS: Nineteen adult patients (5 females) were diagnosed by May 5th, 2020. Median age was 58 (range 55‐72), and median follow‐up since transplantation was 83 (range 20‐183) months. Cough (84.2%), fever (57.9%) and dyspnea (47.4%) were the most common symptoms. Thirteen patients (68.4%) had pneumonia in X‐ray/CT scan. Hydroxychloroquine was administered in 11 patients, associated with lopinavir/ritonavir and interferon β in 2 cases each. Immunomodulatory therapy with tocilizumab was used in 2 patients. Immunosuppression (IS) was halted in one patient, and modified in only other two due to potential drug interactions. Five (26.3%) patients were managed as outpatient. Two patients (10.5%) died, 10 (52.6%) were discharged home, and 2 (10.5%) were still hospitalized after a median follow‐up of 41 days from the onset of symptoms. Baseline IS regimen remained unchanged in all surviving recipients, with good liver function. CONCLUSIONS: Our preliminary experience shows a broad spectrum of disease severity in LT patients with COVID‐19, with a favorable outcome in most of them without needing to modify baseline IS.