Background: The presence of comorbidities and chronic immunosuppression may increase the risk of severe COVID-19 among liver transplant (LT) recipients. The effects of COVID- 19 on liver graft in LT recipients are unclear.
Aims: To systematically review and meta-analyse the outcomes of COVID-19 infection in LT recipients.
Methods: The electronic databases were searched for articles published from 1/12/2019 to 20/5/2021 with MeSH terms COVID-19, SARS-CoV-2, and liver transplantation. LT vs. non- LT patients with COVID-19 infection were compared for all-cause mortality, which was the primary outcome studied. We also evaluated the effect of timing of COVID-19 infection post- LT on mortality.
Results: Eighteen articles reporting 1,522 COVID-19 infected LT recipients were included for the systematic review. The mean age was 60.38 years, and 68.5% were men. The mean time to COVID-19 infection was 5.72 years. Based on 17 studies (I2=7.34) among 1,481 LT recipients, the cumulative incidence of mortality was 17.4% (95%CI, 15.4–19.6). Mortality was comparable between LT (n =610) and non-LT (n=239,704) patients, based on four studies (odds ratio [OR], 0.8 [0.6–1.08]; P=0.14). Additionally, there was no significant difference in mortality between those infected within one year vs. after one year of LT (OR, 1.5 [0.63–3.56]; P = 0.35). 22% of LT patients developed elevated liver chemistries. The cumulative incidence of graft dysfunction was 2.3% (1.3–4.1). Nearly 23% (20.71–25) of the LT patients developed severe COVID-19 infection. The cumulative incidence of acute kidney injury and thrombotic complications was 33.22% and 6%, respectively. Similar proportion of patients required ICU care among LT and non-LT patients (OR,1.35[0.48–3.76];P=0.55). Before infection, 71% and 49% of patients were on tacrolimus and mycophenolate mofetil, respectively. Immunosuppression was modified in 56% of patients after COVID-19 infection.
Conclusions: Outcomes of LT recipients infected with COVID-19 is similar to non-LT patients.