A0502 - Did the COVID-19 Pandemic Impact Liver Transplant Patients?

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Pallavi Patil, MD

Baylor University Medical Center, Pathologist Biomedical Laboratories, Texas A&M College of Medicine
Dallas, TX

Troupe Grimes, MD¹, Rajab Idriss, MD¹, Richard Trieu, MD², Madhuri Mulekar, PhD¹, Phillip Henderson, DO¹, Pallavi Patil, MD³
¹University of South Alabama, Mobile, AL; ²University of Arizona, Tucson, AZ; ³Baylor University Medical Center, Pathologist Biomedical Laboratories, Texas A&M College of Medicine, Dallas, TX

Introduction: Liver transplant patients are a unique population at high risk for opportunistic or viral infections due to chronic immunosuppressive therapy. Our aim was to determine the impact of the COVID-19 pandemic and compliance to immunosuppressive treatment in this cohort.

Methods: Clinicopathological parameters in liver transplant patients before the pandemic and at most recent follow-up during the pandemic were noted. Telephone survey was conducted to supplement chart review.

Results: Of 193 patients, (61% males, 39% females), 15 tested SARS-CoV-2 positive (53% males, 47% females). Mild symptoms were reported in 53%, prolonged symptoms in 53%, hospitalization in 40%, and intensive care (ICU) admission in 7%. Overall survival at 1-, 3-, and 5-year for patients not tested for COVID-19 (85, 66 and 50 months respectively) was higher than those negative (80, 51 and 36 months respectively) (p< 0.01). Race, age at liver transplantation, indication for transplant, compliance to medications, and body mass index did not differ in SARS-CoV-2 positive and negative. Compliance was similar before and during the pandemic in 91.67% cases. There was no difference in acute rejection, chronic rejection, and biliary stricture before and during the pandemic. SARS-CoV-2 positive cases had higher ALP and ALT levels after test (p< 0.05). None of the positive patients underwent a liver biopsy. On telephone survey, 135 patients were successfully contacted, with 121 participating. 93 patients received atleast 1 dose of vaccine, while 28 were unvaccinated. Of 13 total deaths, none were due to COVID-19.

Discussion: Our study reports lower ICU admission and mortality (6.7% and 0%) compared to other studies (10 to 33% and 12 to 18% respectively). Patients testing for SARS-CoV-2 having lower survival may be associated with testing performed for hospital visits for symptoms/complications related to liver transplant follow-up. Liver enzymes (ALP and ALT) were elevated after SARS-CoV-2 infection, may be secondary to drug-induced liver injury related to treatment for COVID-19 or systemic inflammation due to infection. The COVID-19 pandemic did not affect compliance nor mortality. A possible reason could be immunosuppressive drugs reducing severe damage related to inflammatory response. Our findings supports reducing immunosuppression is not needed and will help to mitigate fear of the pandemic among patients, towards maintaining better compliance.

SARS-CoV-2 positive cases	n
Total positive	15/193
None or Mild Symptoms	8/15
Hospitalization	6/15
ICU Admission	1/15
Prolonged symptoms	8/15
Mortality	0/15

Table: Presentation of SARS-CoV2 infection in liver transplant patients

Disclosures:

Troupe Grimes indicated no relevant financial relationships.

Rajab Idriss indicated no relevant financial relationships.

Richard Trieu indicated no relevant financial relationships.

Madhuri Mulekar indicated no relevant financial relationships.

Phillip Henderson indicated no relevant financial relationships.

Pallavi Patil: Astellas Pharma – Advisory Committee/Board Member.

Troupe Grimes, MD¹, Rajab Idriss, MD¹, Richard Trieu, MD², Madhuri Mulekar, PhD¹, Phillip Henderson, DO¹, Pallavi Patil, MD³. A0502 - Did the COVID-19 Pandemic Impact Liver Transplant Patients?, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.