Impact of COVID-19 on liver transplant recipients: A nationwide cohort study evaluating hospitalization, transplant rejection, and inpatient mortality

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has posed a major public health concern worldwide.Patients with comorbid conditions are at risk of adverse outcomes following COVID-19.Solid organ transplant recipients with concurrent immunosuppression and comorbidities are more susceptible to a severe COVID-19 infection.It could lead to higher rates of inpatient complications and mortality in this patient population.However,studies on COVID-19 outcomes in liver transplant(LT)recipients have yielded inconsistent findings.AIM To evaluate the impact of the COVID-19 pandemic on hospital-related outcomes among LT recipients in the United States.METHODS We conducted a retrospective cohort study using the 2019–2020 National Inpatient Sample database.Patients with primary LT hospitalizations and a secondary COVID-19 diagnosis were identified using the International Classi-fication of Diseases,Tenth Revision coding system.The primary outcomes included trends in LT hospitalizations before and during the COVID-19 pandemic.Secondary outcomes included comparative trends in inpatient mortality and transplant rejection in LT recipients.RESULTS A total of 15720 hospitalized LT recipients were included.Approximately 0.8% of patients had a secondary diagnosis of COVID-19 infection.In both cohorts,the median admission age was 57 years.The linear trends for LT hospitalizations did not differ significantly before and during the pandemic(P=0.84).The frequency of in-hospital mortality for LT recipients increased from 1.7% to 4.4% between January 2019 and December 2020.Compared to the pre-pandemic period,a higher association was noted between LT recipients and in-hospital mortality during the pandemic,with an odds ratio(OR)of 1.69[95% confidence interval(CI):1.55-1.84),P<0.001].The frequency of transplant rejections among hospitalized LT recipients increased from 0.2%to 3.6% between January 2019 and December 2020.LT hospitalizations during the COVID-19 pandemic had a higher association with transplant rejection than before the pandemic[OR:1.53(95%CI:1.26-1.85),P<0.001].CONCLUSION The hospitalization rates for LT recipients were comparable before and during the pandemic.Inpatient mortality and transplant rejection rates for hospitalized LT recipients were increased during the COVID-19 pandemic.

Management of chronic hepatitis B during pregnancy

Chronic hepatitis B is globally prevalent and is a major cause of cirrhosis and hepatocellular carcinoma.Despite immunoprophylaxis against hepatitis B in pregnancy,perinatal transmission still occurs in at least 10%of the children born to a mother with high level of viremia.Decisions regarding hepatitis B therapy during pregnancy must take into account the benefits and safety for both the mother and the unborn baby.In this review,we summarize the current treatment options for chronic hepatitis B with a focus on management during pregnancy and the evidence-based strategies to prevent vertical transmission of hepatitis B virus(HBV).

A challenging case of alpha-fetoprotein-result discrepancies in a patient with chronic hepatitis B

Introduction Alpha-fetoprotein(AFP)is the most abundant serum protein found in the human fetus,produced by the yolk sac and the liver[1].The levels of maternal serum AFP reach a peak value at28-32 weeks of gestation and decrease rapidly after birth and usually drop to the normal at 8-12 months of age.The normal serum AFP level for an adult is<20 ng/mL[2].In contrast,livertumor cells usually synthesize and secrete an increased level of AFP.Abdominal ultrasound and AFP are generally recommended as the screening modality for HCC for patients at risk for development of hepatocellular carcinoma(HCC)[1].AFP-L3,an isoform of AFP that binds Lens culinaris agglutinin,can be particularly useful in the early identification of aggressive HCC[2].These assays,however,can generate false-positive and false-negative AFP values.Of patients with advanced HCC,20%had normal AFP levels,whereas some patients with liver diseases had significant AFP elevation without liver cancer in long-term surveillance[3].Elevated AFP levels could be associated with active liver diseases with hepatocyte regeneration[4,5].In that setting,the AFP level will decline with improvement of the underlying liver condition.Our case illustrated the dilemma and uncertainties as a result of persistent abnormal AFP values after extensive clinical investigations.