COVID-19 in a liver transplant recipient: Could iatrogenic immunosuppression have prevented severe pneumonia? A case report

Table 1 Laboratory tests of patients

	No symptoms	Start symptoms	Start treatment	After treatment
Laboratory parameters	February 22	March 10	March 16	March 24
AST, UI/L	24	22	32	26
ALT, UI/L	19	28	16	24
Total bilirubin (µmol/L)	6.5	3.5	8	8
Albumin (g/L)	33	35	33	31
Creatinine (µmol/L)	118.6	119	135	134.5
Hemoglobin (g/L)	12.1	12.5	12.5	11.7
Platelet	159000	122000	136000	296000
Lymphocytes	1020	1050	390	996
PT (%)	100	86	27	88
INR	1	1.05	1.5	1.1
Tacrolimus (ng/mL)	3.5	3.5	3.2	3.8
CRP (mg/L)	3.05	12.4	112.28	6.6

AST: Aspartate transaminase; ALT: Alanine transaminase; PT: Prothrombin time; INR: International normalized ratio; CRP: C reactive protein.

Table 2 Clinical and biological characteristics of patients with coronavirus disease 2019 pneumonia after liver transplanta

Ref.	Study type	Patients (n)	Age (yr)	Time from transplantation	Clinical manifestations	Immunosuppression treatment	Immunosuppression, modification	Metabolic comorbidities	Death
Fernández-Ruiz et al[8]	Case series	6	63	7.9 yr	Fever, shortness of breath, cough	EVE	Yes	Hypertension, diabetes	No
			72	5.5 yr	Fever, shortness of breath, cough	MMF, EVE	Yes	Hypertension, diabetes, obesity	Yes
			79	15.3 yr	Shortness of breath, cough, malaise, diarrhea	Prednisone AZA, EVE	Yes	Diabetes, chronic renal failure	Yes
			73	16.4 yr	Fever, shortness of breath, cough, malaise	MMF	Yes	Diabetes	Yes
			76	26.5 yr	Fever, thoracic, pain	Tacrolimus	No	Hypertension	No
			46	6.4 yr	Diarrhea	Tacrolimus	No		No
Bhoori et al[7]	Correspondence	6	> 65	> 10 yr			Yes		Yes
			> 65	> 10 yr			Yes	Diabetes, overweight, hyperlipidemia	Yes
			> 65	> 10 yr			Yes	Diabetes, overweight, hyperlipidemia	Yes
				< 2 yr		Calcineurin inhibitors	Yes	Diabetes, overweight, hyperlipidemia	No
				< 2 yr		Calcineurin inhibitors	Yes		No
				< 2 yr		Calcineurin inhibitors	Yes		No
Huang et al[9]	Case report	1	59	3 yr	Fever, cough, chills, fatigue, icterus and diarrhea	MMF et tacrolimus			Yes
Qin et al[6]	Case report	1	37	53 d	Persistent fever	Tacrolimus and glucocorticoids			No

EVE: Everolimus; MMF: Mycophenolate mofetil; AZA: Azathioprine.