Efficacy and safety of carrimycin in ten patients with severe pneumonia following solid organ transplantation

BACKGROUND The number of patients undergoing solid organ transplantation has increased annually.However,infections in solid organ transplant recipients can have a severe effect on patient survival owing to the continued use of immunosuppressants.Carrimycin is a novel macrolide antibiotic produced by genetically engineered streptomyces spiramyceticus harboring a 4’’-O-isovaleryltransferase gene(ist)from streptomyces thermotoleran.Carrimycin has good antibacterial and antiviral effects.However,no relevant studies have been conducted on the efficacy and safety of carrimycin in patients with severe pneumonia(SP)after solid organ transplantation.AIM To explore the efficacy and safety of carrimycin in patients with SP after solid organ transplantation to provide a medication reference for clinical treatment.METHODS In March 2022,ten patients with SP following solid-organ transplantation were treated at our hospital between January 2021 and March 2022.When the condition was critical and difficult to control with other drugs,carrimycin was administered.These ten patients'clinical features and treatment protocols were retrospectively analyzed,and the efficacy and safety of carrimycin for treating SP following solid organ transplantation were evaluated.RESULTS All ten patients were included in the analysis.Regarding etiological agent detection,there were three cases of fungal pneumonia,two cases of bacterial pneumonia,two cases of Pneumocystis pneumonia,and three cases of mixed infections.After treatment with carrimycin,the disease in seven patients significantly improved,the course of the disease was significantly shortened,fever was quickly controlled,chest computed tomography was significantly improved,and oxygenation was significantly improved.Finally,the patients were discharged after curing.One patient died of acute respiratory distress syndrome,and two patients discontinued treatment.CONCLUSION Carrimycin is a safe and effective treatment modality for SP following solid organ transplantation.Carrimycin may have antibacterial and antiviral effects in patients with SP following solid organ transplantation.

Relative carcinogenicity of tacrolimus vs mycophenolate after solid organ transplantation and its implications for liver transplant care

BACKGROUND De novo malignancy is a leading cause of late morbidity and mortality in liver transplant recipients.Cumulative immunosuppression has been shown to contribute to post-transplant malignancy(PTM)risk.There is emerging evidence on the differential carcinogenic risk profile of individual immunosuppressive drugs,independent of the net effect of immunosuppression.Calcineurin inhibitors such as tacrolimus may promote tumourigenesis,whereas mycophenolic acid(MPA),the active metabolite of mycophenolate mofetil,may limit tumour progression.Liver transplantation(LT)is relatively unique among solid organ transplantation in that immunosuppression monotherapy with either tacrolimus or MPA is often achievable,which makes careful consideration of the risk-benefit profile of these immunosuppression agents particularly relevant for this cohort.However,there is limited clinical data on this subject in both LT and other solid organ transplant recipients.AIM To investigate the relative carcinogenicity of tacrolimus and MPA in solid organ transplantation.METHODS A literature search was conducted using MEDLINE and Embase databases using the key terms“solid organ transplantation”,“tacrolimus”,“mycophenolic acid”,and“carcinogenicity”,in order to identify relevant articles published in English between 1st January 2002 to 11th August 2022.Related terms,synonyms and explosion of MeSH terms,Boolean operators and truncations were also utilised in the search.Reference lists of retrieved articles were also reviewed to identify any additional articles.Excluding duplicates,abstracts from 1230 records were screened by a single reviewer,whereby 31 records were reviewed in detail.Full-text articles were assessed for eligibility based on pre-specified inclusion and exclusion criteria.RESULTS A total of 6 studies were included in this review.All studies were large population registries or cohort studies,which varied in transplant era,type of organ transplanted and immunosuppression protocol used.Overall,there was no clear difference demonstrated between tacrolimus and MPA in de novo PTM risk following solid organ transplantation.Furthermore,no study provided a direct comparison of carcinogenic risk between tacrolimus and MPA monotherapy in solid organ transplantation recipients.CONCLUSION The contrasting carcinogenic risk profiles of tacrolimus and MPA demonstrated in previous experimental studies,and its application in solid organ transplantation,is yet to be confirmed in clinical studies.Thus,the optimal choice of immunosuppression drug to use as maintenance monotherapy in LT recipients is not supported by a strong evidence base and remains unclear.

Impact of tacrolimus intra-patient variability in adverse outcomes after organ transplantation

Tacrolimus(Tac)is currently the most common calcineurin-inhibitor employed in solid organ transplantation.High intra-patient variability(IPV)of Tac(Tac IPV)has been associated with an increased risk of immune-mediated rejection and poor outcomes after kidney transplantation.Few data are available concerning the impact of high Tac IPV in non-kidney transplants.However,even in kidney transplantation,there is still a controversy whether high Tac IPV is indeed detrimental in respect to graft and/or patient survival.This may be due to different methods employed to evaluate IPV and distinct time frames adopted to assess graft and patient survival in those reports published up to now in the literature.Little is also known about the influence of high Tac IPV in the development of other untoward adverse events,update of the current knowledge regarding the impact of Tac IPV in different outcomes following kidney,liver,heart,lung,and pancreas tran-splantation to better evaluate its use in clinical practice.

Women’s health issues in solid organ transplantation:Breast and gynecologic cancers in the post-transplant population

The success of solid organ transplant has steadily improved which has led to a unique set of post-transplant issues.The rates of de novo cancer in the solid organ transplant recipient population are higher than those in the general population.There is growing evidence that breast and gynecologic cancers may have a higher mortality rate in post-transplant patients.Cervical and vulvovaginal cancers specifically have a significantly higher mortality in this population.Despite this increased mortality risk,there is currently no consistent standard in screening and identifying these cancers in post-transplant patients.Breast,ovarian and endometrial cancers do not appear to have significantly increased incidence.However,the data on these cancers remains limited.Further studies are needed to determine if more aggressive screening strategies would be of benefit for these cancers.Here we review the cancer incidence,mortality risk and current screening methods associated with breast and gynecologic cancers in the post-solid organ transplant population.

Current status of glucocorticoid usage in solid organ transplantation

Glucocorticoids(GCs)have been the mainstay of immunosuppressive therapy in solid organ transplantation(SOT)for decades,due to their potent effects on innate immunity and tissue protective effects.However,some SOT centers are reluctant to administer GCs long-term because of the various related side effects.This review summarizes the advantages and disadvantages of GCs in SOT.PubMed and Scopus databases were searched from 2011 to April 2021 using search syntaxes covering“transplantation”and“glucocorticoids”.GCs are used in transplant recipients,transplant donors,and organ perfusate solution to improve transplant outcomes.In SOT recipients,GCs are administered as induction and maintenance immunosuppressive therapy.GCs are also the cornerstone to treat acute antibody-and T-cell-mediated rejections.Addition of GCs to organ perfusate solution and pretreatment of transplant donors with GCs are recommended by some guidelines and protocols,to reduce ischemia-reperfusion injury peri-transplant.GCs with low bioavailability and high potency for GC receptors,such as budesonide,nanoparticle-mediated targeted delivery of GCs to specific organs,and combination use of dexamethasone with inducers of immuneregulatory cells,are new methods of GC application in SOT patients to reduce side effects or induce immune-tolerance instead of immunosuppression.Various side effects involving different non-targeted organs/tissues,such as bone,cardiovascular,neuromuscular,skin and gastrointestinal tract,have been noted for GCs.There are also potential drug-drug interactions for GCs in SOT patients.

Solid organ transplantations and COVID-19 disease

Tens of thousands of people worldwide became infected with syndrome coronavirus-2(SARS-CoV-2).Death rate in general population is about 1%-6%,but this rate rises up to 15%in those with comorbidities.Recent publications showed that the clinical progression of this disease in organ recipients is more destructive,with a fatality rate of up to 14%-25%.We aimed to review the effect of pandemic on various transplantation patients.coronavirus disease 2019(COVID-19)has not only interrupted waiting list patients’lives;it has also impacted transplantation strategies,transplant surgeries and broke donation chains.COVID-19 was directly and indirectly accountable for 73%surplus in mortality of this population as compared to wait listed patients in earlier years.The impact of chronic immunosuppression on outcomes of COVID-19 remains unclear but understanding the immunological mechanisms related to the virus is critically important for the lifetime of transplantation and immune suppressed patients.It is hard to endorse changing anti-rejection therapy,as the existing data appraised is not adequate to advise substituting tacrolimus with cyclosporine during severe COVID-19 disease.

Research progress of soluble CD83 in organ transplantation

Organ transplantation is considered to be an effective method for the treatment of end-stage organ failure,early malignant tumors and tissue damage.In order to reduce the rejection of the transplanted organ by the host,immunosuppressive drugs should be used for a long time,but the suppression of the host immune system by immunosuppressive drugs can cause serious side effects.Therefore,how to induce the recipient's immune system to have no response to the transplanted organ after transplantation,while still showing a normal immune response to the alien antigen.Induction of immune tolerance to donor organs has long been a focus of research by transplant scientists.Soluble CD83(sCD83)is a glycoprotein with specific immunosuppressive effects.In recent years,there have been more and more reports on the immune tolerance induced by sCD83 in animal experiments,which has shown a broad prospect in the treatment of host immune rejection after organ transplantation and provided an experimental basis for its clinical transformation.

Chances and risks of sodium-glucose cotransporter 2 inhibitors in solid organ transplantation:A review of literatures

Solid organ transplantation offers life-saving treatment for patients with endorgan dysfunction.Patient survival and quality of life have improved over the past few decades as a result of pharmacological development,expansion of the donor pool,technological advances and standardization of practices related to transplantation.Still,transplantation is associated with cardiovascular complications,of which post-transplant diabetes mellitus(PTDM)is one of the most important.PTDM increases mortality,which is best documented in patients who have received kidney and heart transplants.PTDM results from traditional risk factors seen in patients with type 2 diabetes mellitus,but also from specific posttransplant risk factors such as metabolic side effects of immunosuppressive drugs,post-transplant viral infections and hypomagnesemia.Oral hypoglycaemic agents are the first choice for the treatment of type 2 diabetes mellitus in non-transplanted patients.However,the evidence on the safety and efficacy of oral hypoglycaemic agents in transplant recipients is limited.The favourable risk/benefit ratio,which is suggested by large-scale and long-term studies on new glucoselowering drug classes such as glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors,makes studies warranted to assess the potential role of these agents in the management of PTDM.

Bariatric surgery outcomes following organ transplantation:A review study

Weight gain is a frequent postoperative complication following a solid organ transplant which can be solved by bariatric surgery.The outcomes of bariatric surgery among patients with an organ transplant history are always a challengeable subject for surgeons and surgery candidates.In this review article,we aim to investigate the existence literature about the rates of morbidity and mortality,frequent complications in terms of graft function,remission in diabetes,hypertension,pulmonary and cardiovascular disorders,hepatic and renal functions,and immunosuppressive stability,as well as the safety of bariatric surgery among patients.

Clinical analysis of different periods of liver transplantation at an organ transplantation centre

Objective To summarize our clinical experience in liver transplantation while considering the background in this filed in China. Methods Ninety-five patients who had received liver transplantation from April 1993 to March 2002 were analyzed retrospectively. Three periods were defined objectively as period Ⅰ(1993-1997),Ⅱ(1999) and Ⅲ(2000 -2002). Operative techniques, recipients, original diseases, complications and survival rates were compared among the three periods. Results Malignant liver lesions were the main cause for liver transplantation in period Ⅰ and Ⅱ. The ratio of number of malignant disease to total recipients decreased gradually from period Ⅰ to Ⅱ (100%, 53% and 35%, respectively). The 1-year survival rate in patients with benign liver disease was 85 % and the total operative mortality was 5% in period Ⅲ. The incidence of hepatitis B virus reactivation or reinfection was 24% twelve months after liver transplantation. Vascular complication decreased but biliary complications did

Kidney disease in non-kidney solid organ transplantation

Kidney disease after non-kidney solid organ transplantation(NKSOT)is a common post-transplant complication associated with deleterious outcomes.Kidney disease,both acute kidney injury and chronic kidney disease(CKD)alike,emanates from multifactorial,summative pre-,peri-and post-transplant events.Several factors leading to kidney disease are shared amongst solid organ transplantation in addition to distinct mechanisms unique to individual transplant types.The aim of this review is to summarize the current literature describing kidney disease in NKSOT.We conducted a narrative review of pertinent studies on the subject,limiting our search to full text studies in the English language.Kidney disease after NKSOT is prevalent,particularly in intestinal and lung transplantation.Management strategies in the peri-operative and post-transplant periods including proteinuria management,calcineurin-inhibitor minimization/sparing approaches,and nephrology referral can counteract CKD progression and/or aid in subsequent kidney after solid organ transplantation.Kidney disease after NKSOT is an important consideration in organ allocation practices,ethics of transplantation.Kidney disease after SOT is an incipient condition demanding further inquiry.While some truths have been revealed about this chronic disease,as we have aimed to describe in this review,continued multidisciplinary efforts are needed more than ever to combat this threat to patient and allograft survival.

Tacrolimus-induced posterior reversible encephalopathy syndrome following liver transplantation

In this editorial,we talk about a compelling case focusing on posterior reversible encephalopathy syndrome(PRES)as a complication in patients undergoing liver transplantation and treated with Tacrolimus.Tacrolimus(FK 506),derived from Streptomyces tsukubaensis,is a potent immunosuppressive macrolide.It inhibits Tcell transcription by binding to FK-binding protein,and is able to amplify glucocorticoid and progesterone effects.Tacrolimus effectively prevents allograft rejection in transplant patients but has adverse effects such as Tacrolimus-related PRES.PRES presents with various neurological symptoms alongside elevated blood pressure,and is primarily characterized by vasogenic edema on neuroimaging.While computed tomography detects initial lesions,magnetic resonance imaging,especially the Fluid-Attenuated Inversion Recovery sequence,is superior for diagnosing cortical and subcortical edema.Our discussion centers on the incidence of PRES in solid organ transplant recipients,which ranges between 0.5 to 5+ACU-,with varying presentations,from seizures to visual disturbances.The case of a 66-year-old male status post liver transplantation highlights the diagnostic and management challenges associated with Tacrolimus-related PRES.Radiographically evident in the parietal and occipital lobes,PRES underlines the need for heightened vigilance among healthcare providers.This editorial emphasizes the importance of early recognition,accurate diagnosis,and effective management of PRES to optimize outcomes in liver transplant patients.The case further explores the balance between the efficacy of immunosuppression with Tacrolimus and its potential neurological risks,underlining the necessity for careful monitoring and intervention strategies in this patient population.

Plastic surgery after solid organ transplantations

Background More patients receive organ transplantation surgeries due to the advancement in immunosuppressive agents and surgical techniques. Some of those patients may need to undergo plastic or reconstructive surgery. Long-term use of immunosuppressive agents raises some serious problems. Therefore, this study aimed to introduce our experience about the safety and effectiveness of plastic surgeries after solid organ allograft transplantation. Methods A retrospective review of 17 transplant recipients who underwent different reconstructive or cosmetic operations was carried out. The subjects included 1 heart transplant, 1 liver transplant and 15 kidney transplant recipients. Results All patients tolerated the plastic surgery procedures well. Flaps and skin grafts were the main constructive methods. There were no postoperative infections and wound dehiscence. Transferred flaps survived completely. Skin grafts took well. Three of the cosmetic surgery patients were satisfied with the results. Conclusions Immunosuppressed organ transplant recipients can successfully undergo major reconstructive and cosmetic surgery when given special attention.

The fourth case of rabies caused by organ transplantation in China

In January 2019,the fourth rabies case caused by organ transplantation was noticed in China,with the conditions of one per year for the recent four years.Different from the previous cases,there were no definite epidemiological histories of exposure or rabies-related symptoms from this patient.This case strongly supports the call for the legislation of establishing a national-level management that will incorporate the screening programs on donors prior to the practice of organ transplantation to reduce the risks on rabies caused by organ transplantation.

Prognostic Factors of Liver Transplantation for Hepatocellular Carcinoma: A Surveillance, Epidemiology, and End Results (SEER) Database Analysis

Objective We aimed to identify new,more accurate risk factors of liver transplantation for liver cancer through using the Surveillance,Epidemiology,and End Results(SEER)database.Methods Using the SEER database,we identified patients that had undergone surgical resection for non-metastatic hepatocellular carcinoma(HCC)and subsequent liver transplantation between 2010 and 2017.Overall survival(OS)was estimated using Kaplan-Meier plotter.Cox proportional hazards regression modelling was used to identify factors independently associated with recurrent disease[presented as adjusted hazard ratios(HR)with 95%CIs].Results Totally,1530 eligible patients were included in the analysis.There were significant differences in ethnicity(P=0.04),cancer stage(P<0.001),vascular invasion(P<0.001)and gall bladder involvement(P<0.001)between the groups that survived,died due to cancer,or died due to other causes.In the Cox regression model,there were no significant differences in OS at 5 years with different operative strategies(autotransplantation versus allotransplantation),nor at survival at 1 year with neoadjuvant radiotherapy.However,neoadjuvant radiotherapy did appear to improve survival at both 3 years(HR:0.540,95%CI:0.326–0.896,P=0.017)and 5 years(HR:0.338,95%CI:0.153–0.747,P=0.007)from diagnosis.Conclusion This study demonstrated differences in patient characteristics between prognostic groups after liver resection and transplantation for HCC.These criteria can be used to inform patient selection and consent in this setting.Preoperative radiotherapy may improve long-term survival post-transplantation.

Unveiling transplantation research productivity of United States: A bibliometric analysis

BACKGROUND The United States has witnessed significant advancements in the field of organ transplantation over the course of the last five decades,as demonstrated by a notable increase in the quantity of academic research.The presence of a highly dynamic research environment necessitates continuous evaluations to maintain the integrity and progress of the field.AIM To evaluate the total output and thematic emphasis of transplant research conducted in the United States.METHODS On January 10,2023,we conducted a bibliometric search of United States research output in transplantation journals from the Web of Science database's Science Citation Index Expanded.We excluded editorials,meeting abstracts,and other non-article types.We analyzed annual trends,authors,institutions,articles,keywords,and countries collaborating with the United States,using VOSviewer 1.6.18 to create figures and tables.RESULTS The United States published 25956 papers(3078 reviews and 22878 articles)representing 37.7%of the world's scientific output.Canada emerged as the top collaborator with the United States,co-authoring 1263 articles.Leading institutions in United States transplantation research were the University of Pittsburgh(1749 articles),Mayo Clinic(1605 articles),Harvard Medical School(1549 articles),and Johns Hopkins University(1280 articles).The top three keywords with over 2000 occurrences were"recipients,""survival,"and"outcomes,"indicating a focus on graft and recipient outcome markers by United States researchers.CONCLUSION Our findings demonstrate the United States leadership in organ transplantation research,contributing significantly to the global scientific output in this field.However,opportunities exist for fostering expansive partnerships,particularly with developing countries.This study provides valuable insights into the transplantation research landscape in the United States,emphasizing the importance of ongoing evaluations to maintain and propel advancements in this critical medical discipline.The results may facilitate future collaborations,knowledge exchange,and the pursuit of innovative solutions in the realm of organ transplantation.

China organ donation and transplantation update: the Hangzhou Resolution

The much-anticipated change in the practice of organ donation and transplantation in China is now underway and affirmed by an important Hangzhou Resolution promulgated at the 2013 China Transplant Congress.Support of the National Health and Family Planning Commission On October 29,2013,in a meeting of the National Health and Family Planning Commission (NHFPC)officials with Jie-Fu Huang,Head of National Organ Transplant Committee(OTC), Hai-Bo Wang,Director of China Organ Transplant Response System (COTRS)

Liver transplantation using organs from deceased organ donors: a single organ transplant center experience

BACKGROUND： In 2011, a pilot program for deceased organ donation was initiated in China. We describe the first successful series of liver transplants in the pilot program.METHODS： From July 2011 to August 2012, our center performed 26 liver transplants from a pool of 29 deceased donors. All organ donation and allograft procurement were conducted according to the national protocol. The clinical data of donors and recipients were collected and summarized retrospectively.RESULTS： Among the 29 donors, 24 were China Category II donors（organ donation after cardiac death）, and five were China Category III donors（organ donation after brain death followed by cardiac death）. The recipients were mainly the patients with hepatocellular carcinoma. The one-year patient survival rate was 80.8% with a median follow-up of 422（2-696） days. Among the five mortalities during the follow-up,three died of tumor recurrence. In terms of post-transplant complications, 9 recipients（34.6%） experienced early allograft dysfunction, 1（3.8%） had non-anastomotic biliary stricture,and 1（3.8%） was complicated with hepatic arterial thrombosis.None of these complications resulted in patient death. Notably,primary non-function was not observed in any of the grafts.CONCLUSION： With careful donor selection, liver transplant from deceased donors can be performed safely and plays acritical role in overcoming the extreme organ shortage in China.

Randomized intervention to assess the effectiveness of an educational video on organ donation intent among Hispanics in the New York metropolitan area

BACKGROUND The Hispanic community has a high demand for organ donation but a shortage of donors.Studies investigating factors that could promote or hinder organ donation have examined emotional video interventions.Factors acting as barriers to organ donation registration have been classified as:(1)Bodily integrity;(2)medical mistrust;(3)“ick”-feelings of disgust towards organ donation;and(4)“jinx”-fear that registration may result in one dying due to premeditated plans.We predict that by providing necessary information and education about the donation process via a short video,individuals will be more willing to register as organ donors.AIM To determine perceptions and attitudes regarding barriers and facilitators to organ donation intention among Hispanic residents in the New York metropolitan area.METHODS This study was approved by the Institutional Review Board at Northwell Health.The approval reference number is No.19-0009(as presented in Supplementary material).Eligible participants included Hispanic New York City(NYC)residents,18 years of age and above,who were recruited voluntarily through Cloud Research and participated in a larger randomized survey study of NYC residents.The survey an 85-item Redcap survey measured participant demographics,attitudes,and knowledge of organ donation as well as the intention to register as an organ donor.Attention checks were implemented throughout the survey,and responses were excluded for those who did fail.Participants were randomly assigned two-between subject conditions:To view a short video on organ donation and then proceed to complete the survey(i.e.,video first)and view the same video at the end of the survey(video last).No intra-group activities were conducted.This study utilized an evidenced-based emotive educational intervention(video)which was previously utilized and was shown to increase organ donation registration rates at the Ohio Department of Motor Vehicles.Results were analyzed using Jamovi statistical software.Three hundred sixty-five Hispanic individuals were included in the analysis.Once consent was obtained and participants entered the survey(the survey sample is presented in Supplementary material),participants were asked to report on demographic variables and their general impression of organ donation after death.The video depicted stories regarding organ donation after death from various viewpoints,including from the loved ones of a deceased person who died waiting for a transplant;from the loved ones of a deceased person whose organs were donated upon death;and,from those who were currently waiting for a transplant.RESULTS Using a binomial logistic regression,the analysis provides information about the relationship between the effects of an emotive video and the intention to donate among Hispanic participants who were not already registered as donors.The willingness to go back and register was found to be significantly more probable for those who watched the emotive video before being asked about their organ donation opinions(odds ratio:2.05,95%confidence interval:1.06-3.97).Motivations for participation in organ donation were also captured with many stating the importance of messages coming from“people like me”and a message that highlights“the welfare of those in need”.Overall,the findings suggest that using an emotive video that addresses organ donation barriers to prompt organ donation intentions can be effective among the Hispanic populous.Future studies should explore using targeted messaging that resonates with specific cultural groups,highlighting the welfare of others.CONCLUSION This study suggests that an emotive educational intervention is likely to be effective in improving organ donation registration intent among the Hispanic population residing in NYC.

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.