Abstract

Background:

Liver Transplant (LT) recipients are vulnerable to severe infections because of their immunocompromised status. Previous studies had conflicting results regarding the impact of COVID-19 infection on LT recipients. However, most of these studies were single-centered, had a small sample size, or lacked national-level data. In this study, we utilized a large inpatient database to investigate hospital-related outcomes in LT recipients with concurrent COVID-19 infection.

Methods:

We queried the 2020 National Inpatient Sample database to identify LT recipients with COVID-19 hospitalizations who underwent LT in the index hospitalization or had a history of LT. We excluded patients aged <18 years and trauma-related hospitalizations. Our primary outcomes included comparing all-cause inpatient mortality, mechanical ventilation (MV), and intensive care unit (ICU) utilization between COVID and non-COVID groups. Secondary outcomes included resource utilization, including length of stay (LOS) and total hospitalization charges in both groups. We conducted univariate and multivariate regression analyses to identify the independent predictors of mortality.

Results:

A total of 2,259 adult LT recipients hospitalizations with concurrent COVID-19 infection were identified. The mean age of these patients was 62.42 vs. 59.60 years for the LT without COVID-19 group; the majority were male (59.3% vs. 52%) and Caucasian (56.5% vs. 50.6%) in both groups. Patients with LT and COVID-19 infection had higher mortality (13.70% vs. 2.47%, P=0.01) and developed more septic shock (10.6% vs. 7.2%; P=0.01) but had no increase in ICU utilization (11.3% vs.12.3%; P=0.06) or MV requirement (13.9% vs. 11.9%; P= 0.16) as compared to the non-COVID group. Regarding resource utilization, mean LOS (8.96 days vs. 8.17 days; P=0.12) was similar, but mean hospitalization charges were higher in the non-COVID group ($125,961 vs. $177,058; P=0.00). On univariate and multivariate logistic regression analyses, COVID-19 infection, septic shock, MV, and ICU were independent predictors for mortality.

Conclusion:

We found that COVID-19 infection is an independent predictor of mortality in LT recipients, with a 5-fold increase in mortality compared to LT patients without COVID-19. This data (2020) predates the availability of COVID vaccines, and many LT recipients have since been vaccinated. It will be interesting to see if these trends are present for subsequent years of the pandemic. Moreover, when these patients acquire infection, they should be treated promptly with the latest therapies to improve their clinical outcomes.