New Delhi [India], September 4 : Uncomplicated liver transplant recipients who contracted COVID-19 do not necessarily have higher mortality as compared to the non-transplanted population, a study by a private hospital in Delhi claimed. The study by Max Super Speciality Hospital in Delhi under the Department of Gastroenterology and Herpetology and Centre for Liver and Biliary Sciences was conducted on 2,182 adult Indian patients who had undergone liver transplantation at the Centre since 2006 and on regular follow-up. Typically, COVID-19 is associated with higher mortality among patients who have co-morbidities or pre-existing medical conditions such as obesity, diabetes, coronary artery disease, chronic kidney disease and non-alcoholic fatty liver disease. “It is an established fact that patients who have undergone liver transplantation (LT) are on long-term immunosuppressive medications which predispose them to infections. The study is significant because the data regarding the impact of SARS-CoV-2 infection in post LT patients is conflicting, and risk factors for the outcome are also not well defined. While initial studies suggested that patients on immunosuppressive medications, such as liver transplant recipients, are at increased risk of severe COVID-19 and mortality, subsequent evidence did not support this finding,” Dr Subhash Gupta, Chairman, Centre for Liver and Biliary Sciences, Max Super Speciality Hospital at Saket said. Dr Gupta explained, “All post-liver transplant recipients (age>18 years at the time of transplant) on regular follow-up since 2006 including those who tested positive for COVID-19 between April 1, 2020, and May 31, 2021, were included in the study. Under the supervision protocol, the severity of COVID-19 was classified, and patients divided into three groups based on interval from liver transplantation till SARS-CoV-2 infection.” “Of the 3096 patients who underwent a liver transplant at the centre since 2006, 2,182 adult recipients were under regular follow-up and in communication with the centre during the pandemic.” “Of these, 88 patients (3.71 per cent) reported SARSCoV-2 infection, six adults and a child were excluded from the analysis, and 81 patients were included,” he said. The average age of SARS-CoV-2-infected patients in the study was 51.3 years, and 74 patients (91.4 per cent) were males. 21 (25.9 per cent) patients infected with SARS-CoV-2 underwent liver transplants within one year, 36 (44.4 per cent) patients received transplants between one and five years while 24 (29.6 per cent) patients undergone transplant more than 5 years ago. Based on the duration since liver transplant, patients who were infected with SARS-CoV-2 were divided into three groups. Group A had 21 patients who were infected with the disease within one year of a liver transplant, Group B had 36 patients who got LT 1-5 years ago and group C had 24 patients who got LT more than 5 years ago. In final conclusion about the study, Dr Gupta said, “In our study, all patients except one who died had received a liver transplant more than a year ago. After 1-year of transplantation, a dose of immunosuppressive medication is usually significantly reduced and therefore the cytokine storm may not be ameliorated. In our study population, COVID-19-related mortality was 17.3 per cent which is comparable to the 18.2 per cent mortality seen in older patients with co-morbidities. Our study suggests that uncomplicated liver transplant recipients who acquire SARSCoV-2 do not necessarily have higher mortality as compared to similar non transplanted population.” “However, more studies are needed with the larger patient populations and matched control groups to reach a firm conclusion,” he added.
