Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jun 18, 2024; 14(2): 90866
Published online Jun 18, 2024. doi: 10.5500/wjt.v14.i2.90866
Impact of COVID-19 on liver transplant recipients: A nationwide cohort study evaluating hospitalization, transplant rejection, and inpatient mortality
Faisal Inayat, Pratik Patel, Hassam Ali, Arslan Afzal, Hamza Tahir, Ahtshamullah Chaudhry, Rizwan Ishtiaq, Attiq Ur Rehman, Kishan Darji, Muhammad Sohaib Afzal, Gul Nawaz, Alexa Giammarino, Sanjaya K Satapathy
Faisal Inayat, Gul Nawaz, Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Punjab 54550, Pakistan
Pratik Patel, Division of Gastroenterology, Mather Hospital and Zucker School of Medicine at Hofstra University, Port Jefferson, NY 11777, United States
Hassam Ali, Arslan Afzal, Division of Gastroenterology and Hepatology, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
Hamza Tahir, Department of Internal Medicine, Jefferson Einstein Hospital, Philadelphia, PA 19141, United States
Ahtshamullah Chaudhry, Department of Internal Medicine, St. Dominic's Hospital, Jackson, MS 39216, United States
Rizwan Ishtiaq, Department of Internal Medicine, Saint Francis Hospital and Medical Center, Hartford, CT 06105, United States
Attiq Ur Rehman, Division of Hepatology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA 18711, United States
Kishan Darji, Department of Internal Medicine, Campbell University and Cape Fear Valley Medical Center, Fayetteville, NC 28301, United States
Muhammad Sohaib Afzal, Department of Internal Medicine, Louisiana State University Health, Shreveport, LA 71103, United States
Alexa Giammarino, Department of Internal Medicine, North Shore University Hospital and Zucker School of Medicine at Hofstra University, Manhasset, NY 11030, United States
Sanjaya K Satapathy, Division of Hepatology, North Shore University Hospital and Zucker School of Medicine at Hofstra University, Manhasset, NY 11030, United States
Author contributions: Inayat F, Patel P, Ali H, Afzal A, Tahir H, and Chaudhry A concepted and designed the study, participated in the acquisition of data, interpretation of results, writing of the original draft, and critical revisions of the important intellectual content of the final manuscript; Ishtiaq R, Rehman AU, Darji K, Afzal MS, Nawaz G, and Giammarino A contributed to the analysis and interpretation of results and drafting of the manuscript; Satapathy SK reviewed, revised, and improved the manuscript by suggesting pertinent modifications; and all authors critically assessed, edited, and approved the final manuscript and are accountable for all aspects of the work.
Institutional review board statement: The data of patients was not acquired from any specific institution but rather open-access United States National Inpatient Sample (NIS) database. The NIS contains de-identified information, protecting the privacy of patients, physicians, and hospitals. Therefore, it was deemed exempt from the institutional review board (IRB).
Informed consent statement: Participants were not required to give informed consent for this retrospective cohort study since the analysis of baseline characteristics used anonymized clinical data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Faisal Inayat, MBBS, Research Scientist, Department of Internal Medicine, Allama Iqbal Medical College, Allama Shabbir Ahmad Usmani Road, Faisal Town, Lahore, Punjab 54550, Pakistan. faisalinayat@hotmail.com
Received: December 18, 2023
Revised: March 22, 2024
Accepted: April 23, 2024
Published online: June 18, 2024
Processing time: 178 Days and 17.5 Hours
Abstract
BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has posed a major public health concern worldwide. Patients with comorbid conditions are at risk of adverse outcomes following COVID-19. Solid organ transplant recipients with concurrent immunosuppression and comorbidities are more susceptible to a severe COVID-19 infection. It could lead to higher rates of inpatient complications and mortality in this patient population. However, studies on COVID-19 outcomes in liver transplant (LT) recipients have yielded inconsistent findings.

AIM

To evaluate the impact of the COVID-19 pandemic on hospital-related outcomes among LT recipients in the United States.

METHODS

We conducted a retrospective cohort study using the 2019–2020 National Inpatient Sample database. Patients with primary LT hospitalizations and a secondary COVID-19 diagnosis were identified using the International Classification of Diseases, Tenth Revision coding system. The primary outcomes included trends in LT hospitalizations before and during the COVID-19 pandemic. Secondary outcomes included comparative trends in inpatient mortality and transplant rejection in LT recipients.

RESULTS

A total of 15720 hospitalized LT recipients were included. Approximately 0.8% of patients had a secondary diagnosis of COVID-19 infection. In both cohorts, the median admission age was 57 years. The linear trends for LT hospitalizations did not differ significantly before and during the pandemic (P = 0.84). The frequency of in-hospital mortality for LT recipients increased from 1.7% to 4.4% between January 2019 and December 2020. Compared to the pre-pandemic period, a higher association was noted between LT recipients and in-hospital mortality during the pandemic, with an odds ratio (OR) of 1.69 [95% confidence interval (CI): 1.55-1.84), P < 0.001]. The frequency of transplant rejections among hospitalized LT recipients increased from 0.2% to 3.6% between January 2019 and December 2020. LT hospitalizations during the COVID-19 pandemic had a higher association with transplant rejection than before the pandemic [OR: 1.53 (95%CI: 1.26-1.85), P < 0.001].

CONCLUSION

The hospitalization rates for LT recipients were comparable before and during the pandemic. Inpatient mortality and transplant rejection rates for hospitalized LT recipients were increased during the COVID-19 pandemic.

Keywords: Liver transplant recipients; Solid organ transplantation; COVID-19; Hospitalization; Transplant rejection; Mortality

Core Tip: Patients with solid organ transplants may be at higher risk of severe coronavirus disease 2019 (COVID-19). However, there is a dearth of large-scale population-based data. Using a multicenter database, this retrospective cohort study evaluates the impact of the COVID-19 pandemic on hospital-related outcomes for liver transplant (LT) recipients in the United States. Our findings show that the LT hospitalization rates were similar before and during the pandemic. LT recipients had increased rates of inpatient mortality and transplant rejection during the COVID-19 pandemic. It underscores the importance of tailored clinical management to improve outcomes and reduce morbidity and mortality for hospitalized LT recipients.