Liver transplant beneficiaries at no increased risk of mortality of covid without comorbidity: study

A Covid 19 study of adult patients who have undergone Max Healthcare liver transplantation suggests that non-complicated liver transplants with no comorbidity have no elevated coronaviral mortality rate.

The study looked at 2182 people who had undergone liver transplantation at Max Hospital, Saket from 2006. Of these 88 people reported to have got Covid and 81 were included in the study. The average age of patients in the study was 51.3 years.

Among the 81 patients, 35 or 43.2 per cent of the patients had one or more comorbidities. Among the 81, 14 died of Covid-19. Of those who died, three or 6.5 per cent did not have any comorbidities.

Among the patients 22 (27.1 per cent) had diabetes mellitus (DM) as the most common comorbidity while hypertension was present in 3.7 per cent, and 7.4 per cent had DM2 with hypertension. Four of them had chronic kidney disease (CKD) along with DM2, of which one had stage 2 CKD and the other three patients had stage 3 CKD.

In the studied group, 59 (72.8 per cent) were on two immunosuppressants – calcineurin inhibitors (CNIs) and mycophenolate mofetil. 10 (12 per cent) were receiving three immunosuppressive drugs—CNIs, mycophenolate mofetil and prednisolone. 11 (13.5 per cent) were taking single immunosuppressive medication (tacrolimus) only. One patient was on steroids with tacrolimus and everolimus due to a recent rejection episode.

“In our study, all patients who died except one had received a liver transplant more than a year ago. After one year of transplantation, the dosage of immunosuppressive medication is usually significantly reduced and therefore the cytokine storm may not be ameliorated. In our study population, Covid-related mortality was 17.3 per cent which is comparable to the 18.2 per cent mortality seen in older patients with comorbidities. Our study suggests that uncomplicated liver transplant recipients who get infected with coronavirus do not necessarily have higher mortality as compared to similar non transplanted populations. However, more studies are needed with a larger patient population and matched control groups to reach a firm conclusion,” said Dr Subhash Gupta, chairman of the Centre for Liver & Biliary Sciences, at the hospital.