Skip to main content
. 2021 Feb 25;35(4):e14246. doi: 10.1111/ctr.14246

TABLE 3.

Outcomes in liver transplant recipients with COVID‐19 in reviewed studies

Study Modulation in immunosuppressive regimen Other measures Outcome Remarks
Becchetti et al 17

  • CNI withheld/reduced: 19/50 (38%)

  • MMF withheld/reduced: 9/25 (36%)

  • mTORi withheld/reduced: 3/7 (43%)

  • Increased steroid: 19/57 (35%)

  • Lopinavir/ritonavir: 3/57 (5%)

  • Darunavir: 1/57 (2%)

  • HCQ: 24/57 (44%)

  • Azithromycin: 15/57 (27%)

  • Tocilizumab (IL‐6 antagonist): 1/57 (2%)

  • Total death: 7/57 (12%)

  • Inpatient death: 7/37 (19%)

  • Outpatient: 0/20

  • Hospital stay 10 (7‐22) days

  • Mortality (12%)

  • ICU admission 4/41 (10%)

  • ICU mortality 2/4 (50%)

  • No rejection reported

  • No QTc prolongation reported in patients who received HCQ
Fernandez‐Ruiz et al 18

  • CNI withheld/reduced: NA

  • MMF withheld/reduced: 2/2 (100%)

  • mTORi withheld/reduced: 2/3 (66.7%)

  • Increased steroid: NA

  • Lopinavir/ritonavir: 2/6 (67%)

  • HCQ: 4/6 (67%)

  • Total death: 2/6 (33%)

  • Inpatient death: 2/6 (67%)

  • Discharged: 4/6 (67%)

  • Mortality (33%)

  • ICU admission 1/6 (17%)

  • ICU mortality 1/1 (100%)

  • ≥ 1 immunosuppressive (antiproliferative and CNIs) drug withheld: 50%

  • No rejection reported

  • No QTc prolongation reported in patients who received HCQ
Donato et al 21

  • NA

  • NA

  • Total death: 0/8 (0%)

  • Inpatient death: 0/5 (0%)

  • Discharged: 3/5 (60%)

  • Still admitted: 2/5 (40%)

  • Mortality (0%)

  • ICU admission (0%)

  • ≥ 1 immunosuppressive (antiproliferative and CNIs) drug withheld: NA

  • No rejection reported

  • No QTc prolongation reported in patients who received HCQ
Yi et al 22

  • Increase steroid: 1/2 (50%)

  • Immunosuppression modification: NA

  • NA

  • Total death: 0/4 (0%)

  • Inpatient death: 0/2 (0%)

  • Discharged: 2/2 (100%)

  • Mortality (0%)

  • ICU admission (0%)

  • ≥ 1 immunosuppressive (antiproliferative and CNIs) drug withheld: NA

  • No rejection reported
Loinaz et al 23

  • CNI withheld/reduced: 0/8 (0%)

  • MMF withheld/reduced: 1/10 (10%)

  • mTORi withheld/reduced: 2/4 (50%)

  • Increased steroid: 2/14 (14.3%)

  • Lopinavir/ritonavir: 2/14 (14%)

  • HCQ: 11/19 (58%)

  • Tocilizumab (IL‐6 antagonist): 2/14 (14%)

  • Total death: 2/19 (10.5%)

  • Inpatient death: 2/14 (14%)

  • Discharged: 10/14 (71.4%)

  • Still admitted: 2/14 (14.3%)

  • Mortality (10.5%)

  • In‐hospital mortality (14%)

  • ICU admission (14%)

  • ICU mortality 2/2 (100%)

  • ≥ 1 immunosuppressive (antiproliferative and CNIs) drug withheld: 50%

  • Unusual thrombotic even in two patients; one in right hepatic vein/ second degree right portal vein branch and another in hepatic vein‐caval anastomosis

  • No rejection reported

  • No QTc prolongation reported in patients who received HCQ
Webb et al 24

  • NA

  • Lopinavir/ritonavir: 9/151 (6%)

  • HCQ: 38/151 (25%)

  • Remdesivir: 6/151 (4%)

  • Azithromycin: 1/151 (1%)

  • Tocilizumab (IL‐6 antagonist): 2/151 (1%)

  • Total death: 28/151 (19%)

  • Inpatient death: 28/124 (22.5%)

  • Discharged: 96/124 (77%)

  • Mortality (19%)

  • In‐hospital mortality (22.5%)

  • ICU admission (35%)

  • ICU mortality 20/43 (47%)

  • Invasive ventilation: 30/124 (24%)

  • Mortality on MV: 23/30 (53%)

  • Mortality in > 60 y: 23/73 (32%)

  • ≥ 1 immunosuppressive (antiproliferative and CNIs) drug withheld: NA

  • No rejection reported

  • Predictors of mortality on multivariate analysis were age > 60, presence of non‐liver cancer and higher baseline creatinine.
Tschopp et al 25

  • NA

  • NA

  • Total death: 0/5 (0%)

  • Inpatient death: 0/5 (0%)

  • Mortality (0%)

  • ICU admission (0%)
Lee et al 26

  • CNI withheld/reduced: 15/24 (63%)

  • MMF withheld/reduced: 13/13 (10%)

  • Increased steroid: 5/24 (21%)

  • HCQ: 18/24 (75%)

  • Azithromycin: 18/24 (75%)

  • Total death: 7/38 (18%)

  • Inpatient death: 7/24 (29%)

  • Discharged: 14/24 (58.3%)

  • Still admitted: 3/24 (12.5%)

  • Hospital stay 9 (4‐22) days

  • Mortality (18%)

  • In‐hospital mortality: 29%

  • ICU admission (33%)

  • ICU mortality 6/7 (86%)

  • ≥ 1 immunosuppressive (antiproliferative and CNIs) drug withheld: 63%

  • No rejection reported

  • No QTc prolongation reported in patients who received HCQ
Belli et al 27

  • Increased steroid: 17/95 (18%)

  • Lopinavir/ritonavir: 16/95 (17%)

  • HCQ: 63/95 (66%)

  • Azithromycin: 31/95 (33%)

  • Tocilizumab (IL‐6 antagonist): 7/95 (7%)

  • Total death: 16/103 (16%)

  • Inpatient death: 16/83 (19%)

  • Mortality (16%)

  • Mortality in > 60 y: 16/73 (22%)

  • ICU admission (18%)

  • ICU mortality 4/15 (25%)

  • Mortality on MV: 4/9 (44%)

  • ≥ 1 immunosuppressive (antiproliferative and CNIs) drug withheld: 79%

  • No rejection reported

  • No QTc prolongation reported in patients who received HCQ
Colmenero et al 28

  • Immunosuppression withheld/reduced: 73/111 (66%)

  • Increased steroid: 12/96 (12.5%)

  • Lopinavir/ritonavir: 40/96 (42%)

  • HCQ: 88/96 (92%)

  • Azithromycin: 60/96 (62.5%)

  • Tocilizumab (IL‐6 antagonist): 15/96 (16%)

  • Total death: 20/111 (18%)

  • Inpatient death: 20/96 (21%)

  • Still admitted: 10/96 (10.4%)

  • Mortality (18%)

  • Mortality in > 60 y: 16/73 (22%)

  • ICU admission (13%)

  • Invasive ventilation: 9/96 (9%)

  • ≥ 1 immunosuppressive (antiproliferative and CNIs) drug withheld: 66%

  • No rejection reported

  • Three patients had liver graft dysfunction but no graft loss

  • No QTc prolongation reported in patients who received HCQ

  • Mortality rate was lower than general population with SMR (95%CI 94.25‐96.85)

  • Adjusted mortality rate in > 60 y LT group was similar to general population
Patrono et al 20

  • CNI withheld/reduced: 5/9 (55%)

  • MMF withheld/reduced: 3/5 (60%)

  • Increased steroid: 3/9 (33%)

  • Lopinavir/ritonavir: 1/9 (11%)

  • Darunavir: 1/9 (11%)

  • HCQ: 2/9 (22%)

  • Total death: 2/9 (22%)

  • Inpatient death: 2/9 (22%)

  • Mortality (22%)

  • Mortality in > 60 y: 2/6 (33%)

  • ≥ 1 immunosuppressive (antiproliferative and CNIs) drug withheld: 66%

  • No rejection reported
Bhoori et al 19

  • NA

  • NA

  • Total death: 3/6 (50%)

  • Inpatient death: 3/3 (100%)

  • Mortality (50%)

  • All three mortality were witnessed following 10 years of transplant

  • ICU admission (50%)

  • ICU mortality 3/3 (100%)

Abbreviations: CNI: calcineurin inhibitor; HCQ: Hydroxychloroquine; ICU: intensive care unit; IL‐6 antagonist: Interleukin‐6 antagonist; LT: liver transplantation; MMF: Mycophenolate mofetil; mTORi: mammalian target of rapamycin inhibitor; MV: Mechanical ventilation; NA: Not available; QTc: Corrected QT interval; yrs: years.