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Impact of COVID-19 on liver transplant recipients: A nationwide cohort study evaluating hospitalization, transplant rejection, and inpatient mortality
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作者 Faisal Inayat Pratik Patel +10 位作者 Hassam Ali Arslan Afzal Hamza Tahir Ahtshamullah Chaudhry Rizwan Ishtiaq Attiq Ur Rehman Kishan Darji Muhammad Sohaib Afzal Gul Nawaz Alexa Giammarino Sanjaya K Satapathy 《World Journal of Transplantation》 2024年第2期62-75,共14页
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 r... 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. 展开更多
关键词 liver transplant recipients Solid organ transplantation COVID-19 HOSPITALIZATION transplant rejection MORTALITY
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Clinical outcomes of coronavirus disease 2019 in liver transplant recipients 被引量:1
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作者 Muhammad Shafiq Cheryl Gibson 《World Journal of Hepatology》 2022年第6期1142-1149,共8页
BACKGROUND Liver transplant patients are at higher risk of infection due to immunosuppression.Whether liver transplant recipients are also more susceptible to severe acute respiratory syndrome coronavirus 2(SARS-CoV-2... BACKGROUND Liver transplant patients are at higher risk of infection due to immunosuppression.Whether liver transplant recipients are also more susceptible to severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and will have worse outcomes than the general population if they develop coronavirus disease 2019(COVID-19)due to SARS-CoV-2 is a topic of ongoing studies,including ours.AIM To assess the clinical outcomes of COVID-19 in liver transplant recipients.METHODS This was a case-control study,with a database search performed(at the study site)from March 1,2020 through February 28,2021.Patients 18 years or older who tested positive for SARS-CoV-2 via polymerase chain reaction(PCR)were included in the study.Patients with infection other than pneumonia at the time of admission were excluded.After selection,patients who had been the recipient of liver transplant were considered cases and those without as controls.After being matched by age,sex,and obesity,two controls were randomly selected for each case.Death and hospitalization due to COVID-19 infection were the primary outcomes.Secondary outcomes were pertinent only to patients who were hospitalized,and they included duration of hospital stay,need for supplemental oxygen,presence of at least one type of end-organ damage,effects on liver enzymes,incidence of acute liver failure,effect on d-dimer levels,and incidence of venous thromboembolism(VTE).Chi-square or Fisher’s exact test was used to compare all primary and secondary outcomes with the exception of duration of hospital stay and d-dimer levels,which were compared using the Wilcoxon signed-rank test.Alpha criterion was set at 0.05.Logistic regression was performed for each primary outcome(as the dependent variable).Statistical analyses were performed using R software.RESULTS Of the 470 Liver transplant recipients who were tested for COVID-19 via the PCR test,39 patients tested positive(8.3%).There was no significant difference between cases and controls regarding death[odds ratio(OR):2.04,95%confidence interval(CI):0.14–29.17;P=0.60]and hospitalization rates(OR:1.38,95%CI:0.59–3.24;P=0.46).There also was no significant difference between cases and controls with respect to all secondary outcomes.Among all patients who had elevated liver enzymes,their levels were either normalized,improving,or remained stable at the time of discharge.No patient developed acute liver failure.Of the 31 hospitalized patients,27 received a prophylactic anticoagulation dose and no patient developed VTE in either group.Among cases who were hospitalized,immunosuppression was decreased in 5 patients and there was no change in immunosuppression among the remaining 7 patients.One patient died in each of these two subgroups.Logistic regression analysis was done,but all of the models had poor model predictions as well as insignificant predictors(independent variables).Therefore,they could not be used for either prediction or inference.CONCLUSION Clinical outcomes of COVID-19 in liver transplant recipients are not different than those without transplantation.COVID-19 should not impact timely health care access and immunosuppression continuation among these patients. 展开更多
关键词 COVID-19 SARS-CoV-2 liver transplant recipients Clinical outcomes DEATH HOSPITALIZATION
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The application of the necessity-concerns framework in investigating adherence and beliefs about immunosuppressive medication among Chinese liver transplant recipients
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作者 Hong-Xia Liu Sha Teng +4 位作者 Xiao-Hong Lin Ya-Bin Shang Lu Wang Jing Zhang Yun-Jin Zang 《Chinese Nursing Research》 CAS 2017年第1期14-17,共4页
Objective: This study aimed to explore adherence to and beliefs about immunosuppressive medication using the Necessity-Concerns Framework(NCF) in liver transplant recipients.Methods: A cross-sectional study perfor... Objective: This study aimed to explore adherence to and beliefs about immunosuppressive medication using the Necessity-Concerns Framework(NCF) in liver transplant recipients.Methods: A cross-sectional study performed in recipients who were at least 3 months post liver transplantation. A convenience sample of 243 recipients was recruited. Self-reported medication adherence was measured by the Basel Assessment of Adherence with Immunosuppressive Medication Scale(BAASIS). The NCF was operationalized using the Beliefs about Medication Questionnaire(BMQ) to assess the beliefs about necessity and concerns with taking immunosuppressive medication.Results: One-hundred-forty-five liver transplant recipients were non-adherent(59.67%). Compared to adherers, non-adherers had lower beliefs regarding the necessity of taking immunosuppressive medication and lower scores on the necessity-concerns different from adherers.Conclusions: Non-adherence is common in liver transplant recipients. Non-adherers hold beliefs that are different from adherers. Efforts to increase adherence should be made by targeting medication beliefs. 展开更多
关键词 liver transplant recipients lmmunosuppressive medication Medication adherence Belief in medication Necessity-concerns framework
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Rapamycin increased development of CD4^+ CD25~h ighFoxp3^+ T cells of peripheral blood in liver transplant recipients
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作者 褚志强 《外科研究与新技术》 2011年第4期275-276,共2页
Objective To investigate the possible influence of immunosuppressive therapy,including sirolimus ( SRL) and calcineurin inhibitors ( CNI,tacrolimus) ,on level of Treg in liver allo - graft recipients. Methods Forty - ... Objective To investigate the possible influence of immunosuppressive therapy,including sirolimus ( SRL) and calcineurin inhibitors ( CNI,tacrolimus) ,on level of Treg in liver allo - graft recipients. Methods Forty - seven liver transplant recipients with stable liver function were assessed for at least 2 years,and divided into 展开更多
关键词 CD25~h ighFoxp3 Rapamycin increased development of CD4 T cells of peripheral blood in liver transplant recipients CNI
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Adult-to-adult living donor liver transplantation for acute liver failure in China 被引量:1
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作者 Ding Yuan Fei Liu +6 位作者 Yong-Gang Wei Bo Li Lv-Nan Yan Tian-Fu Wen Ji-Chun Zhao Yong Zeng Ke-Fei Chen 《World Journal of Gastroenterology》 SCIE CAS CSCD 2012年第48期7234-7241,共8页
AIM:To investigate the long-term outcome of recipients and donors of adult-to-adult living-donor liver transplantation(AALDLT) for acute liver failure(ALF).METHODS:Between January 2005 and March 2010,170 living donor ... AIM:To investigate the long-term outcome of recipients and donors of adult-to-adult living-donor liver transplantation(AALDLT) for acute liver failure(ALF).METHODS:Between January 2005 and March 2010,170 living donor liver transplantations were performed at West China Hospital of Sichuan University.All living liver donor was voluntary and provided informed consent.Twenty ALF patients underwent AALDLT for rapid deterioration of liver function.ALF was defined based on the criteria of the American Association for the Study of Liver Diseases,including evidence of coagulation abnormality [international normalized ratio(INR) ≥ 1.5] and degree of mental alteration without pre-ex-isting cirrhosis and with an illness of < 26 wk duration.We reviewed the clinical indications,operative procedure and prognosis of AALDTL performed on patients with ALF and corresponding living donors.The potential factors of recipient with ALF and corresponding donor outcome were respectively investigated using multivariate analysis.Survival rates after operation were analyzed using the Kaplan-Meier method.Receiver operator characteristic(ROC) curve analysis was undertaken to identify the threshold of potential risk factors.RESULTS:The causes of ALF were hepatitis B(n = 18),drug-induced(n = 1) and indeterminate(n = 1).The score of the model for end-stage liver disease was 37.1 ± 8.6,and the waiting duration of recipients was 5 ± 4 d.The graft types included right lobe(n = 17) and dual graft(n = 3).The mean graft weight was 623.3 ± 111.3 g,which corresponded to graft-torecipient weight ratio of 0.95% ± 0.14%.The segment Ⅴor Ⅷ hepatic vein was reconstructed in 11 right-lobe grafts.The 1-year and 3-year recipient's survival and graft survival rates were 65%(13 of 20).Postoperative results of total bilirubin,INR and creatinine showed obvious improvements in the survived patients.However,the creatinine level of the deaths was increased postoperatively and became more aggravated compared with the level of the survived recipients.Multivariate analysis showed that waiting duration was independently correlated with increased mortality(P = 0.014).Furthermore,ROC curve revealed the cut-off value of waiting time was 5 d(P = 0.011,area under the curve = 0.791) for determining the mortality.The short-term creatinine level with different recipient's waiting duration was described.The recipients with waiting duration ≥ 5 d showed the worse renal function and higher mortality than those with waiting duration < 5 d(66.7% vs 9.1%,P = 0.017).In addition,all donors had no residual morbidity.Furthermore,univariate analysis did not show that short assessment time induced the high morbidity(P = 0.573).CONCLUSION:Timely AALDLT for patients with ALF greatly improves the recipient survival.However,further systemic review is needed to investigate the optimal treatment strategy for ALF. 展开更多
关键词 Acute liver failure Adult-to-adult liver donor liver transplantation Recipient Donor Risk factors
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