Analyzing the Impact of Covid-19 in the Hospitalized Cohort of Liver Transplant Recipients: An Early Systematic Review and Meta-Analysis

J. Kumar¹, I. Reccia², P. Bachul¹, D. DiSabato,¹, R. Barth¹, J. Fung¹, T. Baker¹, P. Witkowski¹

¹University of Chicago, Chicago, IL, ²Imperial College, London, United Kingdom

Meeting: 2021 American Transplant Congress

Abstract number: 745

Keywords: Infection, Liver transplantation

Topic: Clinical Science » Infectious Disease » All Infections (Excluding Kidney & Viral Hepatitis)

Session Information

Session Name: All Infections (Excluding Kidney & Viral Hepatitis)

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: To determine pooled prevalence of outcomes among hospitalized liver transplant recipients with COVID-19 through meta-analysis.

*Methods: A database search was completed between Dec1, 2019-Nov15, 2020, as PRISMA guidelines and random-effect analysis performed. Twelve studies, 517 hospitalized liver transplant patients with COVID-19 were included.

*Results: Common presenting symptoms were fever(71%), cough(62%), dyspnea(48%), and gastrointestinal symptoms(28%). 77%(95%CI, 61%-93%) transplant were due to cirrhosis. The most prevalent co-morbidities were hypertension(55%), diabetes(45%) and cardiac disease(21%)(Table-1,2). In-hospital mortality was 20%(95%CI, 13%-28%); which arose significantly in ICU group 41% (95%CI, 19%-63%)(P value<0.00)(Fig1:A,B). Further, analysis showed significantly increased mortality-risk in elderly(OR=4.26)(95%CI, 13%-28%) but no significant effect in terms of gender or time since transplant(Fig1:C-E).

*Conclusions: We observed a higher prevalence of dyspnea, gastrointestinal symptoms than general population. In-hospital mortality was congruent with non-transplant population with multiple co-morbidities but appeared to be less than decompensated cirrhotic patients(26-40%) as reported in literature. Further, higher mortality risk observed in elderly could be attributed to age-associated co-morbidities.

Table 1: Summary statistics outlined as pooled estimate of outcomes of interests
Attributes	Events	Total	Studies	Pooled prevalence (95%)
Age (yrs)	NA	502	9	63.58 (59.66 – 67.48)
Diabetes	211	486	8	0.45 (0.38 – 0.53)
Hypertension	251	486	8	0.55 (0.47 – 0.64)
Cardiac disease	88	472	7	0.21 (0.13 – 0.30)
Lung disease	42	352	6	0.14 (0.06 – 0.22)
ARDS	81	146	5	0.56 (0.26 – 0.86)
ITU admissions	95	417	12	0.22 (0.12 – 0.32)

Table 2: Summary statistics outlined as pooled estimate of outcomes of interests
Attributes	Events	Total	Studies	Pooled prevalence (95%)
Fever	240	350	8	0.71 (0.61-0.81)
Cough	213	342	7	0.62 (0.53-0.72)
Dyspnea	144	353	9	0.48 (0.36-0.61)
Gastrointestinal symptoms	87	293	6	0.28 (0.20-0.35)
CNI withheld/reduced	39	91	4	0.38 (0.09-0.67)
MMF withheld/reduced	28	55	5	0.60 (0.17-0.90)
Increase/pulse steroid	59	283	7	0.22 (0.13-0.31)

To cite this abstract in AMA style:

Kumar J, Reccia I, Bachul P, DiSabato D, Barth R, Fung J, Baker T, Witkowski P. Analyzing the Impact of Covid-19 in the Hospitalized Cohort of Liver Transplant Recipients: An Early Systematic Review and Meta-Analysis [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/analyzing-the-impact-of-covid-19-in-the-hospitalized-cohort-of-liver-transplant-recipients-an-early-systematic-review-and-meta-analysis/. Accessed May 24, 2025.

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