Detalle Publicación


Protective role of tacrolimus, deleterious role of age and comorbidities in liver transplant recipients with Covid-19: results from the ELITA/ELTR Multi-center European Study

Autores: Belli, L. S.; Fondevila, C.; Cortesi, P. A.; Conti, S.; Karam, V.; Adam, R.; Coilly, A.; Ericzon, B. G.; Loinaz, C.; Cuervas-Mons, V.; Zambelli, M.; Llado, L.; Díaz-Fontenla, F.; Invernizzi, F.; Patrono, D.; Faitot, F.; Bhooori, S.; Pirenne, J.; Perricone, G.; Magini, G.; Castells, L.; Detry, O.; Martí Cruchaga, Pablo; Colmenero, J.; Berrevoet, F.; Rodríguez, G.; Ysebaert, D.; Radenne, S.; Metselaar, H.; Morelli, C.; De-Carlis, L. G.; Polak, W. G.; Duvoux, C.; ELITA-ELTR COVID-19 Registry
Título de la revista: GASTROENTEROLOGY
ISSN: 0016-5085
Volumen: 160
Número: 4
Páginas: 1151 - 1163
Fecha de publicación: 2021
BACKGROUND AND AIMS: Despite concerns that liver transplant (LT) recipients may be at increased risk of unfavorable outcomes from COVID-19 due the high prevalence of co-morbidities, immunosuppression and ageing, a detailed analysis of their effects in large studies is lacking. METHODS: Data from adult LT recipients with laboratory confirmed SARS-CoV2 infection were collected across Europe. All consecutive patients with symptoms were included in the analysis. RESULTS: Between March 1 and June 27, 2020, data from 243 adult symptomatic cases from 36 centers and 9 countries were collected. Thirty-nine (16%) were managed as outpatients while 204 (84%) required hospitalization including admission to the ICU (39 of 204, 19.1%). Forty-nine (20.2%) patients died after a median of 13.5 (10-23) days, respiratory failure was the major cause. After multivariable Cox regression analysis, age >70 (HR, 4.16; 95% CI, 1.78-9.73) had a negative effect and tacrolimus (TAC) use (HR, 0.55; 95% CI, 0.31-0.99) had a positive independent effect on survival. The role of comorbidities was strongly influenced by the dominant effect of age where comorbidities increased with the increasing age of the recipients. In a second model excluding age, both diabetes (HR, 1.95; 95% CI, 1.06-3.58) and chronic kidney disease (HR, 1.97; 95% CI, 1.05-3.67) emerged as associated with death CONCLUSIONS: Twenty-five percent of patients requiring hospitalization for COVID-19 died, the risk being higher in patients older than 70 and with medical co-morbidities, such as impaired renal function and diabetes. Conversely, the use of TAC was associated with a better survival thus encouraging clinicians to keep TAC at the usual dose.