The Impacts of the COVID-19 Pandemic on Liver Transplant Patients; Time to Change the Priorities

Incidence, characteristics, and outcome of COVID-19 in patients on liver transplant program: a retrospective study in the north of Iran

The risk of severe coronavirus disease-2019 (COVID-19) disease seems to be higher in individuals with solid organ transplantation. Therefore, the purpose of the present research is to investigate the incidence of COVID-19 and laboratory data and epidemiologic factors in liver transplant recipients and the patients on the waiting list for liver transplantation. In this study, we evaluated the records of patients on the waiting list for liver transplantation and of recipients of a liver transplant. Demographic data, underlying disease, history of drug use and participants' outcomes were collected. The diagnosis of SARS-CoV-2 infection for all patients was confirmed using a nasopharyngeal swab specimen with real-time RT-PCR. During the study period, 172 patients were enrolled, among whom 85 patients (49.4%) were on the waiting list for liver transplantation, and 87 patients (50.6%) were recipients of a liver transplant. Out of them, 10 (5.8%) had a positive result for SARS-CoV-2. Of these patients, 7.05% (6/85) and 4.6% (4/87) of patients on the waiting list and recipients of liver transplants were positive for SARS-CoV-2, respectively. Patients on the waiting list with COVID-19 infection had a higher median of albumin, ALT, AST, TBIL, DBIL, HDL and LDL value. In summary, the incidence of COVID-19 in liver transplant patients was slightly higher. The existence of underlying liver diseases should be well known as one of the poor predictive factors for worse outcomes in patients with COVID-19. So, comparative studies are recommended to identify risk factors for COVID-19 in patients with liver injury.

Clinical Manifestations and Characterization of COVID-19 in Liver Transplant Recipients: A Systematic Review of Case Reports and Case Series

BACKGROUND

This systematic review is conducted to explore available information on clinical presentations, laboratory finding and outcomes of SARS-COV-2 in liver transplant patients.

METHODS

We searched four databases for relevant terms related to COVID-19 and liver transplantation and collected both case reports and case series on liver transplantation published up to the end of September 2020.

RESULTS

After initial screening of irrelevant articles, 25 studies were included and analyzed in this review. Among the 59 patients included, 78.3% were over 50 years old, and 71.6% were males. The majority of patients (93.3%) were hospitalized. The most common presenting symptoms were fever (72.9%) followed by dyspnea and cough (54.2%). The majority of patients revealed a high level of CRP (64.3%). Moreover, high level ALT, AST and ALP were reported in 64.3, 37.5, 30.5 and 22.2% of patients. A total, 9(15.3%), of cases died as a result of complications of COVID-19. Chest radiographs were reported in 72.9%(43/59) of cases that 94% demonstrated radiologic evidence of abnormality.

CONCLUSION

The results demonstrated that the most prevalent symptoms and signs were fever, dyspnea and cough. Moreover, most patients were males and hospitalized. The rate of mortality and high level of CRP, ALT/AST and ALP is similar within the non-immune suppressed and general population. However, early detection of high level of serum CRP, ALT/AST and ALP combined with a clinical COVID-19 symptom and finding of CT scan may be used as an index for the presence and severity of the disease.

The characteristics of cancerous patients infected with COVID-19 in hospital setting

Purpose:

recently, Covid 19 as a fatal virus has been known as the cause of the pandemic. Different number of the mortality rate in various societies have been reported. However, it seems the underlying comorbidities increase the risk of mortality and the severity of presentation. In this study we evaluated the pattern of presentation of COVID-19 among cancerous patients in terms of severity.

Method:

Between 20^th February to 22nd April of 2020, in Taleghani Hospital as a COVID-19 referral hospital, among 214 hospitalized patients because of COVID-19. 41 patients revealed the cancer as a synchronous comorbidity. These patients based on the severity of COVID-19 infection presentation were divided to mild and severe groups. Then, the demographic characteristics, manifestation and laboratory data between these groups were compared.

Result:

about 19 (46.34%) of 41 cases were categorized as severe forms of COVID-19 with malignancy. The mean age of severe groups was significantly higher (P=0.00). Dyspnea (48.78%), cough (46.34%) and myalgia (24.39%) were the most common clinical features among cancerous patients with COVID-19. Diarrhea caused significant effects on severe form of presentation of COVID-19 infection (P=0.05). Hematological cancers were the most frequent types of cancer among these patients (46.34%).

Conclusion:

The elderly age, the positive chemotherapy history, diarrhea, cough, PLT and elevated CRP correlated with a severe form of this infection in malignant cases. (www.actabiomedica.it)

Critical Considerations for Hepatopanceratobilliary Surgeries During COVID-19 Pandemic

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Risk factors related to liver injury in non-Intensive Care Unit admitted patients infected with COVID-19: A retrospective study of 102 patients

BACKGROUND

COVID-19 targets the liver and there is no available data about liver injury due to mild to moderate form of COVID-19. In this study, we evaluated the risk factors associated with liver injury in NON-ICU admitted COVID-19 patients.

METHODS

in this retrospective study, 102 eligible adult participants admitted in the ward were included. The patients with previous history of liver disease were excluded. The patients with AST or ALT or bilirubin more than normal ranges were allocated in liver injury group and patients with normal ranges of them were categorized in non-liver injury. Characteristics and laboratory data were analyzed between these two groups.

RESULTS

The mean age of the population was 55.13± 17.02 years old. The most common symptom was fever (45.8%). The most frequent co-morbidity was hypertension (25%). 65 patients had liver injury (63.72%). CRP were significantly higher in liver injury group (P=0.01). Univariate analysis reported ALKP, and CRP was associated significantly with liver injury (P=0.04, OR= 1.003, Cl 95%= 1.000-1.007; P=0.03, OR= 1.009, Cl 95%= 1.000- 1.017, respectively). No independent factor was detected in multivariate analysis. Based on the Spearman's rank correlation coefficients CRP correlated significantly with AST (r=0.22, P=0.00). Moreover, neutrophil and CRP, correlated with ALT (r=0.01, P=0.90; r=0.23, P=0.02, respectively).

CONCLUSION

No independent factor was detected to predict liver injury chance due to COVID-19. However, CRP had a significant association with it. It appears that the role of inflammatory pathways in liver damage was due to COVID-19.