Table 1.
Clinical Characteristics of COVID-19 in Hospitalized LT Recipientsa
| Variables | Severity of COVID-19 for hospitalized patients |
|||
|---|---|---|---|---|
| Overall (N = 24a) | Mild to moderate (n = 13, 54%) | Severe (n = 11, 46%) | P value | |
| Age, y | 66 (30–80) | 65 (30–80) | 66 (39–79) | .62 |
| Age ≥65 y, n (%) | 14 (58) | 8 (62) | 6 (55) | 1 |
| Body mass index, kg/m2, median (range) | 28.4 (18.7–46.6) | 26.8 (18.7–46.6) | 31.9 (24.3–35.7) | .25 |
| Obesity, BMI ≥ 30 kg/m2, n (%) | 10 (42) | 4 (31) | 6 (55) | .41 |
| Comorbidities, at least 1, n (%) | 22 (92) | 12 (92) | 10 (91) | 1 |
| Hypertension | 17 (71) | 7 (54) | 10 (91) | .08 |
| Diabetes mellitus | 12 (50) | 6 (46) | 6 (55) | 1 |
| Cardiovascular disease | 10 (42) | 5 (38) | 5 (45) | 1 |
| Chronic kidney disease | 17 (71) | 11 (85) | 6 (55) | .18 |
| Time from LT, y, median (range) | 4.7 (0.02–28.2) | 10.6 (0.1–27.2) | 3.6 (0.02–28.2) | .23 |
| Days since symptom onset to hospital, median (range) | 7 (1–30) | 7 (1–21) | 7 (1–30) | .74 |
| Imaging findings of COVID-19, n (%) | 22 (92) | 11 (85) | 11 (100) | .48 |
| Laboratory assessment on admission | ||||
| Alkaline phosphatase, U/L, median (range) | 131 (48–1302) | 159 (49–915) | 79 (48–1302) | .35 |
| Total bilirubin, mg/dL, median (range) | 0.7 (0.2–4.5) | 0.6 (0.2–3.9) | 1.0 (0.4–4.5) | .20 |
| AST, U/L, median (range) | 31 (10–1691) | 32 (10–1691) | 29 (12–255) | .91 |
| ALT, U/L, median (range) | 22 (5–1578) | 24 (5–1578) | 19 (5–199) | .58 |
| Albumin, g/dL, median (range) | 3.2 (1.7–4.3) | 3.1 (1.7–4.3) | 3.3 (2.2–4.3) | .77 |
| INR, median (range) | 1.1 (1.0–1.9) | 1.1 (1.0–1.2) | 1.2 (1.0–1.9) | .06 |
| Lymphocyte count, ×103/μL, median (range) | 0.6 (0.2–5.6) | 0.6 (0.2–5.6) | 0.6 (0.2–1.5) | .75 |
| Acute kidney injury, n (%) | 13 (54) | 6 (46) | 8 (73) | .44 |
| Inflammatory variables on admission, median (range) | ||||
| Ferritin, ng/mL | 986 (36–4677) | 871 (71–4677) | 1148 (36–2909) | .69 |
| C-reactive protein, mg/L | 65.9 (6.2–430.3) | 56.4 (6.2–314.0) | 80.7 (26.9–430.3) | .46 |
| Procalcitonin, ng/mL | 0.33 (0.08–36.46) | 0.36 (0.08–11.44) | 0.30 (0.09–36.46) | .73 |
| Lactate dehydrogenase, U/L | 314 (160–889) | 287 (160–702) | 315 (253–889) | .25 |
| D-dimer, μg/mL | 1.67 (0.27–8.62) | 1.63 (0.27–8.53) | 2.50 (0.27–8.62) | .75 |
| Serum cytokine profile, median (range)b | ||||
| Interleukin 6, pg/mL | 66.3 (12.5–218.0) | 45.7 (12.5–162.0) | 71.6 (19.5–218.0) | .25 |
| Interleukin 8, pg/mL | 44 (13.2–100.0) | 42.3 (16.7–88.1) | 47.1 (13.2–100.0) | 1 |
| Interleukin 1β, pg/mL | 0.5 (0.3–1.8) | 0.6 (0.3–1.8) | 0.5 (0.3–0.8) | .32 |
| Tumor necrosis factor α, pg/mL | 33.7 (15.6–111.0) | 41.1 (21.3–74.5) | 29.1 (15.6–111.0) | .28 |
| Therapy provided, n (%) | ||||
| Supplemental oxygenation | 18 (75) | 7 (54) | 11 (100) | .02 |
| Mechanical ventilation | 8 (33) | 0 | 8 (73) | <.01 |
| Hydroxychloroquine ± azithromycin therapy | 18 (75) | 8 (62) | 10 (91) | .17 |
| Intravenous glucocorticoid therapy | 5 (21) | 0 | 5 (45) | .01 |
| Anticoagulation therapy | 8 (33) | 1 (8) | 7 (64) | .01 |
| Type of immunosuppression before admission, n (%) | ||||
| Tacrolimus | 23 (96) | 13 (100) | 10 (91) | .46 |
| Cyclosporine | 1 (4) | 0 | 1 (9) | .46 |
| Mycophenolic acid | 13 (54) | 6 (46) | 7 (64) | .44 |
| Corticosteroid | 12 (50) | 6 (46) | 6 (55) | 1 |
| Decrease in immunosuppression, n (%) | ||||
| Overall regimen | 19 (79) | 9 (69) | 10 (91) | .33 |
| Calcineurin inhibitorc | 15 (63) | 7 (54) | 8 (73) | .42 |
| Mycophenolic acidc | 13 (100) | 6 (100) | 7 (100) | — |
| Corticosteroidc | 2 (17) | 1 (17) | 1 (17) | 1 |
| Intensive care, n (%) | 8 (33) | 0 | 8 (73) | <.01 |
| Discharged, n (%) | 14 (58) | 12 (92) | 2 (18) | <.01 |
| Length of stay,bd, median (range) | 9 (4–22) | 8 (4–19) | 18 (13–22) | .07 |
| Death, n (%) | 7 (29) | 0 | 7 (64) | <.01 |
| Remain hospitalized, n (%) | 3 (13) | 1 (8) | 2 (18) | .58 |
NOTE. Wilcoxon signed-rank test and Fisher’s test were used to compare samples and proportions as appropriate. All statistical analyses were performed using R 3.6.1 (R Foundation for Statistical Computing, Vienna, Austria). Bolded values indicate P-values less than .05 (for visual purposes).
ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; INR, internationalized ratio.
a
n = 24 (27 patients were hospitalized, 3 at outside medical centers with unavailable data).
b
n = 19.
c
Total number derived from the type of immunosuppression taken.