Table 1.

Clinical and laboratorial data of four long‐term liver transplant recipients with COVID‐19

	Case 1	Case 2	Case 3	Case 4
Age (y)/sex	42/female	59/female	62/female	43/male
Comorbidities	Ureterolithiasis; chronic rejection	Obesity (BMI 31.1 kg/m2); diabetes	Obesity (BMI 36.2 kg/m); systemic arterial hypertension	Crohn's disease; PSC recurrence; nephrolithiasis
Years after liver transplantation	5	3	8	8
Symptoms	Abdominal pain; anosmia; diarrhea; and fever	Dry cough; nasal congestion; and fever	Headache; myalgia; chills; diarrhea; and fever	Headache; asthenia; diarrhea; and fever
Days of symptoms at admission	4	6	15	7
Immunosuppressive treatment at admission	FK 2 mg; MMF 1080 mg; Pd 5 mg	FK 3 mg; MMF 720 mg; Pd 5 mg	FK 4 mg; MMF 720 mg; Pd 10 mg	FK 1,5 mg; Aza 50 mg
Clinical data at admission a	RR = 28 bpm; HR = 150 bpm; RAOS = 96%; T = 38.4°C	1) RR = 20 bpm; HR = 94 bpm; RAOS = 96%; 2) RR = 28 bpm; HR = 100 bpm; RAOS = 94%	1) RR = 24 bpm; HR = 68 bpm; RAOS = 93% 2) RR = 23 bpm; HR = 98 bpm; RAOS = 86%	RR = 20 bpm; HR = 76 bpm; RAOS = 97%; T = 37.2°C BP = 87 × 57 mm Hg
Abnormal Laboratorial tests at admission and at discharge	Lymphocytes 0.39 0,49 at D5 2.0 at discharge Plt 138 95 at D5 279 at discharge C‐RP 0.3 177 at D5 1.3 at discharge LDH 280	Lymphocytes 1.1 0.86 at D5 1.35 at discharge Creatinine 1.22 1.03 at D5 D‐dimer 325 1,630 at D5 C‐RP 130 124 at D5 190 at D7 LDH 283	Lymphocytes 0.44 2.63 at discharge Creatinine 1.88 (→1.32 at discharge D‐dimer 710 C‐RP 66.5 6.4 at discharge LDH 330	WBC 1.2 Lymphocytes 0.71 Plt 73 C‐RP 36.3 Creatinine 2.16 1.25 at D2 D‐dimer 16 531 656 at D2
Chest CT scan	Bilateral and multifocal ground‐glass opacities—lung involvement < 50%	Admission—multiple ground‐glass opacities—lung involvement 25%‐50% D5—worsening—lung involvement 50%	Rare ground‐glass opacities—lung involvement < 25%	Multiple ground‐glass opacities—lung involvement < 50%
SARS‐CoV‐2 real‐time PCR b	positive	positive	Admission—negative D3—positive	positive
Immunosuppression during hospitalization	Antimetabolite withdrawal; PD 10 → 5 mg; FK stable	Antimetabolite withdrawal; PD 5 → 10 mg; FK stable	Antimetabolite withdrawal; PD 10 → 5 mg; FK stable	Antimetabolite withdrawal; ↓ FK dosage due to renal function worsening during 3 d
Clinical treatment	Ceftriaxone (D2) Azithromycin (D2) Oseltamivir Piperacillin‐tazobactam (D7) Prophylactic LMWHd	Ceftriaxone (D7) Azithromycin (D5) Oseltamivir Prophylactic LMWH D5 of hospitalization ↑LMWH to 1 mg/kg/d; HCQ for 5 d; MPD 1 mg/kg/d for 5 d	Ceftriaxone (D7) Azithromycin (D5) Oseltamivir Prophylactic LMWH	Ceftriaxone (D7) Azithromycin (D5) Oseltamivir Prophylactic LMWH
Outcomes c	No oxygen supplementation; discharge after 13 d of hospitalization	Clinical worsening at D5 non‐invasive oxygen supplementation; discharge after 15 d of hospitalization	No oxygen supplementation; discharge after 6 d of hospitalization	No oxygen supplementation; discharge after 10 d of hospitalization

Abbreviations: Aza, azathioprine; BP, blood pressure; C‐RP, C‐reactive protein (<5 mg/L); d, day; D‐dimer normal value < 500 ng/mL; FK, tacrolimus; HCQ, hydroxychloroquine sulfate; HCV, hepatitis C virus; HR, heart rate; LDH, lactate dehydrogenase (<214 U/l); LMWH, low molecular weight heparin (40 mg/d); MMF, sodium mycophenolate; MPD, methylprednisolone; NASH, non‐alcoholic steatohepatitis; normal reference value of lymphocytes = 1.5‐3.5 10³/mm³; Pd, prednisone; Plt, platelets (150‐400 10³/mm³); PSC, primary sclerosing cholangitis; RAOS, room air oxygen saturation; RR, respiratory rate; T, temperature; WBC, white blood cells (4‐11 10³/mm³).

^a Cases 2 and 3 were discharged by the emergency room assistant team and readmitted 48 h latter due to worsening symptoms. None of the patients presented significant liver enzymes elevation or loss of graft function.

^b All patients tested negative for influenza virus.

^c None of the patients was admitted to intensive care unit.