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.
Por:
Belli LS, Fondevila C, Cortesi PA, Conti S, Karam V, Adam R, Coilly A, Ericzon BG, Loinaz C, Cuervas-Mons V, Zambelli M, Llado L, Diaz F, Invernizzi F, Patrono D, Faitot F, Bhooori S, Pirenne J, Perricone G, Magini G, Castells L, Detry O, Cruchaga PM, Colmenero J, Berrevoet F, Rodriguez G, Ysebaert D, Radenne S, Metselaar H, Morelli C, De Carlis L, Polak WG, Duvoux C and ELITA-ELTR COVID-19 Registry
Publicada:
1 mar 2021
Ahead of Print:
9 dic 2020
Resumen:
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 1st and June 27th2020, 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 (39/204, 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 co-morbidities 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 per cent 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.
Filiaciones:
Belli LS:
Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
Fondevila C:
Department of General and Digestive Surgery, Hospital Clínic, Institut d'Investigacion Biomediques August Pi-Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
Cortesi PA:
Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
Conti S:
Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
Karam V:
European Liver Transplant Registry, Centre Hépatobiliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul-Brousse, Paris-Saclay University, Villejuif, France
Adam R:
European Liver Transplant Registry, Centre Hépatobiliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul-Brousse, Paris-Saclay University, Villejuif, France
Coilly A:
Centre Hepato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Paul-Brousse, Paris-Sud Saclay University, Villejuif, France
Ericzon BG:
Division of Transplantation Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden
Loinaz C:
Chirugía General, Doce de Octubre Universidad Complutense de Madrid, Madrid, Spain
Cuervas-Mons V:
Departimento de Medicina, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
Zambelli M:
Department of Surgery, "Papa Giovanni XXIII" Hospital, Bergamo, Department of Surgery, Bergamo, Lombardia, Italy
Llado L:
Liver Transplant Unit, Hospital Uniersitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
Diaz F:
Unidad de Trasplante Hepático, Hospital General Universitario Gregorio Marañón, Madrid, Spain
Invernizzi F:
Division of Gastroenterology and Hepatology, University of Milan, Milan, Italy
Patrono D:
Liver Transplantation Center, Molinette Hospital, Turin, Italy
Faitot F:
Service de Chirurgie Hépatobiliaire et Transplantation, Hôpital de Hautepierre, Strasbourg, France
Bhooori S:
Department of Surgery and Oncology, Istituto Nazionale Tumori, Milan, Italy
Pirenne J:
Department of Surgery, University Hospitals Leuven, Leuven, Belgium
Perricone G:
Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
Magini G:
Service de Transplantation, Hôpitaux Universitaires de Genève, Geneva, Switzerland
Castells L:
Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
Detry O:
Department of Abdominal Surgery and Transplantation, Centre Hospitalier Universitaire Liege, University of Liege, Liege, Belgium
Cruchaga PM:
Cirugía General y Digestiva, Clínica Universidad de Navarra, Pamplona, Spain
Colmenero J:
Department of General and Digestive Surgery, Hospital Clínic, Institut d'Investigacion Biomediques August Pi-Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
Berrevoet F:
Department of General and Hepatobiliary Surgery, Ghent University, Ghent, Belgium
:
Department of General & Digestive Surgery, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario de Alicante, Alicante, Spain
Ysebaert D:
Department of Surgery, Antwerp University Hospital, Antwerp University, Edegem, Belgium
Radenne S:
Service d'Hépato-Gastroentérologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
Metselaar H:
Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, the Netherlands
Morelli C:
Liver and Multi-organ Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
De Carlis L:
General Surgery and Abdominal Transplantation Unit, Niguarda-Cà Granda Hospital, and School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
Polak WG:
Department of Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
Duvoux C:
Department of Hepatology and Medical Liver Transplant Unit, Henri Mondor Hospital Assistance Publique-Hôpitaux de Paris, Paris-Est University, Creteil, France
Green Published, Bronze
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