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Kuo YF, Kwo P, Wong RJ, Singal AK. Impact of COVID-19 on Liver Transplant Activity in the USA: Variation by Etiology and Cirrhosis Complications. J Clin Transl Hepatol 2023; 11:130-135. [PMID: 36406316 PMCID: PMC9647098 DOI: 10.14218/jcth.2022.00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/17/2022] [Accepted: 07/04/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIMS The COVID-19 pandemic has impacted the care of patients with liver disease. We examined impact of COVID-19 on liver transplant (LT) activity in the USA. METHODS LT listings in the United Network for Organ Sharing (UNOS) database (April 2018-May 2021) were analyzed to examine the impact of COVID-19 pandemic on the LT activity based on etiology: hepatitis C virus (HCV), alcohol-associated liver disease (ALD), alcoholic hepatitis (AH), and nonalcoholic steatohepatitis (NASH) complications: hepatocellular carcinoma (HCC) and acute-on-chronic liver failure (ACLF) grade 2 or 3) and Model for End-Stage Liver Disease (MELD) score. Joinpoint regression models assessed time trend changes on a log scale. RESULTS Of 23,871 recipients (8,995 in the COVID era, April 2018-February 2020), mean age 52 years, 62% men, 61% Caucasian, 32% ALD, 15% HCC, 30% ACLF grades 2-3, and mean MELD score 20.5), monthly LT changes were a decrease of 3.4% for overall LTs and 22% for HCC after September 2020, and increase of 4.5% for ALD since 11/2020 and 17% since 03/2021 for ACLF grade 2-3. Monthly MELD scores increased by 0.7 and 0.36 after June 2020 for HCV and HCC respectively. CONCLUSIONS The COVID-19 pandemic has impacted LT activity, with a decrease of LTs especially for HCC, and an increase of LTs for ALD and severe ACLF. Strategies are needed to reorganize cirrhosis patients to overcome the aftereffects of COVID-19 pandemic.
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Affiliation(s)
- Yong-Fang Kuo
- Department of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
- Correspondence to: Ashwani K. Singal, University of South Dakota Sanford, School of Medicine, Avera McKennan University Hospital and Avera Transplant Institute, Sioux Falls, SD 57105, USA. ORCID: https://orcid.org/0000-0003-1207-3998. Tel: +1-605-322-8535 (office) and +1-605-322-5989 (research), Fax: +1-605-322-8536, E-mail: ; Yong-Fang Kuo, University of Texas Medical Branch, Galveston, TX 77755, USA. ORCID: https://orcid.org/0000-0003-1927-0927. Tel: +1-409-772-5276, Fax: +1-409-772-9127, E-mail:
| | - Paul Kwo
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ashwani K. Singal
- University of South Dakota Sanford, School of Medicine, Vermillion, SD, USA
- Avera Transplant Institute, Sioux Falls, SD, USA
- Correspondence to: Ashwani K. Singal, University of South Dakota Sanford, School of Medicine, Avera McKennan University Hospital and Avera Transplant Institute, Sioux Falls, SD 57105, USA. ORCID: https://orcid.org/0000-0003-1207-3998. Tel: +1-605-322-8535 (office) and +1-605-322-5989 (research), Fax: +1-605-322-8536, E-mail: ; Yong-Fang Kuo, University of Texas Medical Branch, Galveston, TX 77755, USA. ORCID: https://orcid.org/0000-0003-1927-0927. Tel: +1-409-772-5276, Fax: +1-409-772-9127, E-mail:
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Vijayashanker A, Aluvihare V, Suddle A, Sanchez-Fueyo A, Cerisuelo MC, Melendez HV, Jassem W, Menon KV, Heaton N, Prachalias A, Srinivasan P. The positive impact of the COVID 19 pandemic on organ utilisation in liver transplantation. JOURNAL OF LIVER TRANSPLANTATION 2023; 9:100131. [PMID: 38013774 PMCID: PMC9824940 DOI: 10.1016/j.liver.2022.100131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/21/2022] [Accepted: 09/25/2022] [Indexed: 01/08/2023] Open
Abstract
Background As the world recovers from the aftermath of devastating waves of an outbreak, the ongoing Coronavirus disease 2019 pandemic has presented a unique perspective to the transplantation community of ''organ utilisation'' in liver transplantation, a poorly defined term and ongoing hurdle in this field. To this end, we report the key metrics of transplantation activity from a high-volume liver transplantation centre in the United Kingdom over the past two years. Methods Between March 2019 and February 2021, details of donor liver offers received by our centre from National Health Service Blood & Transplant, and of transplantation were reviewed. Differences in the activity before and after the outbreak of the pandemic, including short term post-transplant survival, have been reported. Results The pandemic year at our centre witnessed a higher utilisation of Donation after Cardiac Death livers (80.4% vs. 58.3%, p = 0.016) with preserved United Kingdom donor liver indices and median donor age (2.12 vs. 2.02, p = 0.638; 55 vs. 57 years, p = 0.541) when compared to the pre-pandemic year. The 1- year patient survival rates for recipients in both the periods were comparable. The pandemic year, that was associated with increased utilisation of Donation after Cardiac Death livers, had an ischaemic cholangiopathy rate of 6%. Conclusions The pressures imposed by the pandemic led to increased utilisation of specific donor livers to meet patient needs and minimise the risk of death on the waiting list, with apparently preserved early post-transplant survival. Optimum organ utilisation is a balancing act between risk and benefit for the potential recipient, and technologies like machine perfusion may allow surgeons to increase utilisation without compromising patient outcomes.
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Key Words
- COVID 19, Coronavirus disease 2019
- Covid-19
- DBD, Donation after brain death
- DCD, Donation after cardiac death
- Deceased donor
- ICU, Intensive care unit
- Liver transplantation
- MELD, Model for End Stage Liver Disease score
- NHSBT, National Health Service Blood & Transplant
- NLOS, National Liver Offering Scheme
- Organ utilisation
- Pandemic
- TBS, Transplant Benefit Score
- UK DLI, United Kingdom Donor Liver Index
- UKELD, United Kingdom Model for End Stage Liver Disease score
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Affiliation(s)
- Aarathi Vijayashanker
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill SE59RS, England
| | - Varuna Aluvihare
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill SE59RS, England
| | - Abid Suddle
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill SE59RS, England
| | - Alberto Sanchez-Fueyo
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill SE59RS, England
| | - Miriam Cortes Cerisuelo
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill SE59RS, England
| | - Hector V Melendez
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill SE59RS, England
| | - Wayel Jassem
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill SE59RS, England
| | - Krishna V Menon
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill SE59RS, England
| | - Nigel Heaton
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill SE59RS, England
| | - Andreas Prachalias
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill SE59RS, England
| | - Parthi Srinivasan
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill SE59RS, England
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Aydın O, Çolakoğlu MK, Öter V, Mehmet Özgün Y, Pişkin E, Arı D, Akdoğan Kayhan M, Özmen MM, Bostancı EB. COVID-19 infection frequency and clinical course in patients with liver transplantation: Results of a single transplant center in Türkiye. Turk J Surg 2022; 38:283-288. [PMID: 36846059 PMCID: PMC9948660 DOI: 10.47717/turkjsurg.2022.5612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 07/19/2022] [Indexed: 12/24/2022]
Abstract
Objectives In this paper, it was tried to determine the incidence of COVID-19, course of the disease, and mortality rate in liver transplant patients by evaluating all patients operated on in our center. In addition, the results of liver transplantation performed in our center during the pandemic period were also presented. Material and Methods All patients who had undergone liver transplantation in our liver transplant center were questioned about their history of COVID-19 either at their routine controls in the clinic or by phone interview. Results Our liver transplant unit had 195 registered liver transplantation patients (2002-2020), and 142 of these were still alive and under follow-up. During the pandemic period, 80 patients referred to our outpatient clinic for follow-up, and their records were evaluated retrospectively in January 2021. Among 142 liver transplant patients, a total of 18 (12.6%) COVID-19 patients were identified. While 13 of these patients were males, mean age of the patients at the time of interviews was 48.8 years (22-65 years). Nine of the patients had living donor liver transplant, and the rest had cadaveric liver transplant. The most common COVID-19 associated symptom in the patients was fever. During the pandemic period, 12 liver transplant operations were performed in our center. Nine of them were living donor liver transplantation and the remainder were cadaveric liver transplantations. Two of our patients got COVID-19 positive during this period. One of them who was transplanted after COVID treatment was followed-up in intesive care for a long time and was lost not related to COVID-19. Conclusion The incidence of COVID-19 is higher in liver transplant patients than in the general population. Nonetheless, mortality rates are low. During the pandemic period, liver transplantation can be continued by following general precautions.
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Affiliation(s)
- Osman Aydın
- Department of Gastrointestinal Surgery, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
| | - Muhammet Kadri Çolakoğlu
- Department of Gastrointestinal Surgery, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
| | - Volkan Öter
- Department of Gastrointestinal Surgery, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
| | - Yiğit Mehmet Özgün
- Department of Gastrointestinal Surgery, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
| | - Erol Pişkin
- Department of Gastrointestinal Surgery, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
| | - Derya Arı
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
| | - Meral Akdoğan Kayhan
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
| | - Mehmet Mahir Özmen
- Department of Surgery, İstinye University Faculty of Medicine, İstanbul, Türkiye
| | - Erdal Birol Bostancı
- Department of Gastrointestinal Surgery, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
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Sagnelli C, Macera M, Camaioni C, Salvati A, Coppola N, Sagnelli E. SARS-CoV-2 infection: a hurricane that does not ignore chronic hepatitis. Infection 2022; 50:849-858. [PMID: 35316530 PMCID: PMC8938965 DOI: 10.1007/s15010-022-01804-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/09/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND The COVID-19 pandemic significantly compromised screening, laboratory controls, clinical surveillance and treatment of chronic hepatitis patients and worsened their outcome, as evidenced by its significant correlation with advanced cirrhosis, liver decompensation and mortality. RESULTS This pandemic significantly impaired also the sector of liver transplantation, whose wards, operating rooms, outpatients' facilities, and healthcare personnel have been dedicated to patients with COVID-19. In addition, screening and treatment for HBV infection have been delayed or suspended in in most countries, with an increased risk of viral reactivation. Similar delay or suspension have also occurred for universal hepatitis B vaccination programs in many countries. Likewise, COVID-19 pandemic has made unreachable the goal of elimination of HCV infection as a worldwide public-health issue predicted for 2030 by the WHO. CONCLUSION This review article demonstrates how COVID-19 pandemic is causing serious damage to the sector of liver disease, which has quickly lost the beneficial effects of years of study, research, and clinical and technological application, as well as considerable financial investments.
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Affiliation(s)
- Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80101, Naples, Italy
| | - Margherita Macera
- Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80101, Naples, Italy
| | - Clarissa Camaioni
- Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80101, Naples, Italy
| | - Annabella Salvati
- Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80101, Naples, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80101, Naples, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80101, Naples, Italy.
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Akbulut S, Sahin TT, Ince V, Yilmaz S. Impact of COVID-19 pandemic on clinicopathological features of transplant recipients with hepatocellular carcinoma: A case-control study. World J Clin Cases 2022; 10:4785-4798. [PMID: 35801031 PMCID: PMC9198872 DOI: 10.12998/wjcc.v10.i15.4785] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/17/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on the management of all diseases. Various diseases such as cancer have a higher risk of COVID-19-related death. Despite this fact, any delay or alteration in treatment of cancer may have fatal consequences. Hepatocellular carcinoma (HCC) is an aggressive liver cancer that requires multimodality treatment to improve survival.
AIM To evaluate the impact of COVID-19 on the management of patients with HCC by determining changes in demographic, clinical and histopathological variables.
METHODS Demographic, clinical and pathological variables of patients with HCC who had undergone liver transplantation between March 2020 and June 2021 (Pandemic group, n = 48) were retrospectively compared with that of the patients with HCC transplanted between November 2018 and March 2020 (Pre-pandemic group, n = 61).
RESULTS The median age of the patients in the study was 56 (interquartile range = 15). Ninety-seven patients (89%) were male and 12 were female (11%). The most common etiology of liver disease was hepatitis B virus (n = 52, 47.7%). According to our results, there was a 21.3% drop in the number of patients transplanted for HCC. There was no difference in the demographic, clinical and pathological characteristics of the patients except blood alkaline phosphatase levels (P = 0.029), lymphovascular invasion (P = 0.019) and type of the liver graft that was transplanted (P = 0.017).
CONCLUSION It is important to develop a surveillance strategy for liver transplant centers. The liver transplantation for HCC is justified and safe provided that strict surveillance protocols are applied.
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Affiliation(s)
- Sami Akbulut
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Tevfik Tolga Sahin
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Volkan Ince
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Sezai Yilmaz
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
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Hong JJ, Hwang S, Moon DB, Kim YH, Shin S, Kim IO, Lee SR, Lee AY, Woo J. An analysis of the number of liver and kidney transplantations during COVID-19 pandemic in Korea. KOREAN JOURNAL OF TRANSPLANTATION 2021; 35:247-252. [PMID: 35769853 PMCID: PMC9235458 DOI: 10.4285/kjt.21.0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 02/06/2023] Open
Abstract
Background The severity of the coronavirus disease 2019 (COVID-19) pandemic has discouraged organ donation. However, the prevalence of COVID-19 in Korea was much lower in comparison to Western countries. With this, the authors decided to determine the real-world impact of COVID-19 on organ donation and transplantation in Korea. Methods The number of kidney transplantations (KTs) and liver transplantations (LTs) performed in 2020 were compared with those in 2019 using the Korean Network for Organ Sharing database and Asan Medical Center (AMC) database. Results The annual number of deceased donors (DDs) was 450 in 2019 compared to 478 in 2020. Monthly DD number was 37.5±5.9 in 2019 and 39.8±4.4 in 2020 (P=0.284). Annual number of DD kidney transplant (DDKT) was 794 in 2019 and 848 in 2020, and monthly number was 66.1±10.4 in 2019 and 70.7±9.8 in 2020 (P=0.285). The annual number of DDLT was 391 in 2019 and 395 in 2020, and the monthly number was 32.6±5.7, 2019 and 32.9±4.7 in 2020 (P=0.877). The annual number of living donor (LD) KT was 2,293 in 2019 and 1,432 in 2020, and the monthly number was 191.1±19.5 in 2019 and 119.3±11.7 in 2020 (P<0.001). Annual number of living donor LDLT was 1,577 in 2019 and 1,146 in 2020, and monthly number was 131.4±18.1 in 2019 and 95.5±8.0 in 2020 (P<0.001). In the AMC, not all types of KT and LT changed significantly. Conclusions The results of this study indicate that the number of DD organ transplantations remained stable in Korea in 2020, but the number of LD organ transplantations was significantly reduced. However, the number of organ transplantations did not change in the AMC.
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Affiliation(s)
- Jung-Ja Hong
- Organ Transplantation Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Organ Transplantation Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deog-Bok Moon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hoon Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Shin
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Ok Kim
- Organ Transplantation Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae-Rom Lee
- Organ Transplantation Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ah-Young Lee
- Organ Transplantation Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jiwon Woo
- Organ Transplantation Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Gato S, Lucena-Valera A, Muñoz-Hernández R, Sousa JM, Romero-Gómez M, Ampuero J. Impact of COVID-19 on liver disease: From the experimental to the clinic perspective. World J Virol 2021; 10:301-311. [PMID: 34909404 PMCID: PMC8641041 DOI: 10.5501/wjv.v10.i6.301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/18/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has caused a global pandemic unprecedented in over a century. Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a predominantly respiratory infection, various degrees of liver function abnormalities have been reported. Pre-existing liver disease in patients with SARS-CoV-2 infection has not been comprehensively evaluated in most studies, but it can critically compromise survival and trigger hepatic decompensation. The collapse of the healthcare services has negatively impacted the diagnosis, monitoring, and treatment of liver diseases in non-COVID-19 patients. In this review, we aim to discuss the impact of COVID-19 on liver disease from the experimental to the clinic perspective.
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Affiliation(s)
- Sheila Gato
- SeLiver Group, Instituto de Biomedicina de Sevilla, Sevilla 41013, Spain
| | - Ana Lucena-Valera
- Digestive Department, Hospital Universitario Virgen del Rocio, Sevilla 41013, Spain
| | - Rocío Muñoz-Hernández
- SeLiver Group, Instituto de Biomedicina de Sevilla, Sevilla 41013, Spain
- University of Seville, Sevilla 41013, Spain
| | - José Manuel Sousa
- Digestive Department, Hospital Universitario Virgen del Rocio, Sevilla 41013, Spain
| | - Manuel Romero-Gómez
- SeLiver Group, Instituto de Biomedicina de Sevilla, Sevilla 41013, Spain
- Digestive Department, Hospital Universitario Virgen del Rocio, Sevilla 41013, Spain
- University of Seville, Sevilla 41013, Spain
| | - Javier Ampuero
- SeLiver Group, Instituto de Biomedicina de Sevilla, Sevilla 41013, Spain
- Digestive Department, Hospital Universitario Virgen del Rocio, Sevilla 41013, Spain
- University of Seville, Sevilla 41013, Spain
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Tan EXX, Quek WL, Suryadi, Chahed H, Iyer SG, Jeyaraj PR, Lee GH, Chan A, Cheng S, Hoe J, Tan EK, Chew LY, Fung J, Chen M, Muthiah MD, Huang DQ. Impact of COVID-19 on Liver Transplantation in Hong Kong and Singapore: A Modelling Study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 16:100262. [PMID: 34514452 PMCID: PMC8421812 DOI: 10.1016/j.lanwpc.2021.100262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Liver transplantation (LT) activities during the COVID-19 pandemic have been curtailed in many countries. The impact of various policies restricting LT on outcomes of potential LT candidates is unclear. METHODS We studied all patients on the nationwide LT waitlists in Hong Kong and Singapore between January 2016 and May 2020. We used continuous time Markov chains to model the effects of different scenarios and varying durations of disruption on LT candidates. FINDINGS With complete cessation of LT, the projected 1-year overall survival (OS) decreased by 3•6%, 10•51% and 19•21% for a 1-, 3- and 6-month disruption respectively versus no limitation to LT, while 2-year OS decreased by 4•1%, 12•55%, and 23•43% respectively. When only urgent (acute-on-chronic liver failure [ACLF] or acute liver failure) LT was allowed, the projected 1-year OS decreased by a similar proportion: 3•1%, 8•41% and 15•20% respectively. When deceased donor LT (DDLT) and urgent living donor LT (LDLT) were allowed, 1-year projected OS decreased by 1•2%, 5•1% and 8•85% for a 1-, 3- and 6-month disruption respectively. OS was similar when only DDLT was allowed. Complete cessation of LT activities for 3-months resulted in an increased projected incidence of ACLF and hepatocellular carcinoma (HCC) dropout at 1-year by 49•1% and 107•96% respectively. When only urgent LT was allowed, HCC dropout and ACLF incidence were comparable to the rates seen in the scenario of complete LT cessation. INTERPRETATION A short and wide-ranging disruption to LT results in better outcomes compared with a longer duration of partial restrictions. FUNDING None to disclose.
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Affiliation(s)
- Eunice Xiang-Xuan Tan
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Wei Liang Quek
- School of Humanities, Nanyang Technological University, Singapore
| | - Suryadi
- School of Physical and Mathematical Sciences, Nanyang Technological University, Singapore
| | - Haroun Chahed
- School of Humanities, Nanyang Technological University, Singapore
| | - Shridhar Ganpathi Iyer
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
- Department of Surgery, National University Health System, Singapore
| | - Prema Raj Jeyaraj
- SingHealth Duke-NUS Transplant Centre, Singapore
- Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Guan-Huei Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Albert Chan
- Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation, Department of Surgery, The University of Hong Kong, China
| | - Stephanie Cheng
- Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Jan Hoe
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Ek Khoon Tan
- SingHealth Duke-NUS Transplant Centre, Singapore
- Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Lock Yue Chew
- School of Physical and Mathematical Sciences, Nanyang Technological University, Singapore
| | - James Fung
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Melvin Chen
- School of Humanities, Nanyang Technological University, Singapore
| | - Mark D. Muthiah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Daniel Q. Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
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Loinaz-Segurola C, Marcacuzco-Quinto A, Fernández-Ruiz M. Coronavirus disease 2019 in liver transplant patients: Clinical and therapeutic aspects. World J Hepatol 2021; 13:1299-1315. [PMID: 34786167 PMCID: PMC8568575 DOI: 10.4254/wjh.v13.i10.1299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/17/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted liver transplant (LT) activity across the world, with notable decreases in the number of donations and procedures in most Western countries, in particular throughout the first wave. The cumulative incidence of COVID-19 in LT recipients (with estimates ranging from 0.34% to 1.56%) appears to be at least comparable to that observed for the general population. Clinical and radiological features at presentation are also similar to non-transplant patients. The risk of death among LT recipients requiring hospital admission is high (from 12% to 19%), although some authors have suggested that overall mortality may be actually lower compared to the general non-transplant population. It is likely that these poor outcomes may be mainly influenced by the older age and higher comorbidity burden of LT recipients, rather than by the transplant status itself. In fact, it has been hypothesized that post-transplant immunosuppression would exert a protective role, with special focus on tacrolimus-containing regimens. There is scarce evidence to guide the optimal management of post-transplant COVID-19 and the use of antiviral or immunomodulatory therapies, although both clinical practice and guidelines support the dose reduction or withdrawal of anti-proliferative agents such as mofetil mycophenolate. Preliminary reports suggest that the antibody response to messenger RNA vaccines is significantly impaired as compared to non-immunocompromised individuals, in line with other transplant populations. Finally, it is foreseeable that the future will be conditioned by the emerging variants of severe acute respiratory syndrome coronavirus 2 with increased transmissibility among LT recipients.
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Affiliation(s)
- Carmelo Loinaz-Segurola
- HBP and Transplant Surgery Unit. Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid 28041, Spain.
| | - Alberto Marcacuzco-Quinto
- HBP and Transplant Surgery Unit. Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid 28041, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid 28041, Spain
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Aubert O, Yoo D, Zielinski D, Cozzi E, Cardillo M, Dürr M, Domínguez-Gil B, Coll E, Da Silva MI, Sallinen V, Lemström K, Midtvedt K, Ulloa C, Immer F, Weissenbacher A, Vallant N, Basic-Jukic N, Tanabe K, Papatheodoridis G, Menoudakou G, Torres M, Soratti C, Hansen Krogh D, Lefaucheur C, Ferreira G, Silva HT, Hartell D, Forsythe J, Mumford L, Reese PP, Kerbaul F, Jacquelinet C, Vogelaar S, Papalois V, Loupy A. COVID-19 pandemic and worldwide organ transplantation: a population-based study. Lancet Public Health 2021; 6:e709-e719. [PMID: 34474014 PMCID: PMC8460176 DOI: 10.1016/s2468-2667(21)00200-0] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/02/2021] [Accepted: 08/16/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Preliminary data suggest that COVID-19 has reduced access to solid organ transplantation. However, the global consequences of the COVID-19 pandemic on transplantation rates and the effect on waitlisted patients have not been reported. We aimed to assess the effect of the COVID-19 pandemic on transplantation and investigate if the pandemic was associated with heterogeneous adaptation in terms of organ transplantation, with ensuing consequences for waitlisted patients. METHODS In this population-based, observational, before-and-after study, we collected and validated nationwide cohorts of consecutive kidney, liver, lung, and heart transplants from 22 countries. Data were collected from Jan 1 to Dec 31, 2020, along with data from the same period in 2019. The analysis was done from the onset of the 100th cumulative COVID-19 case through to Dec 31, 2020. We assessed the effect of the pandemic on the worldwide organ transplantation rate and the disparity in transplant numbers within each country. We estimated the number of waitlisted patient life-years lost due to the negative effects of the pandemic. The study is registered with ClinicalTrials.gov, NCT04416256. FINDINGS Transplant activity in all countries studied showed an overall decrease during the pandemic. Kidney transplantation was the most affected, followed by lung, liver, and heart. We identified three organ transplant rate patterns, as follows: countries with a sharp decrease in transplantation rate with a low COVID-19-related death rate; countries with a moderate decrease in transplantation rate with a moderate COVID-19-related death rate; and countries with a slight decrease in transplantation rate despite a high COVID-19-related death rate. Temporal trends revealed a marked worldwide reduction in transplant activity during the first 3 months of the pandemic, with losses stabilising after June, 2020, but decreasing again from October to December, 2020. The overall reduction in transplants during the observation time period translated to 48 239 waitlisted patient life-years lost. INTERPRETATION We quantified the impact of the COVID-19 pandemic on worldwide organ transplantation activity and revealed heterogeneous adaptation in terms of organ transplantation, both at national levels and within countries, with detrimental consequences for waitlisted patients. Understanding how different countries and health-care systems responded to COVID-19-related challenges could facilitate improved pandemic preparedness, notably, how to safely maintain transplant programmes, both with immediate and non-immediate life-saving potential, to prevent loss of patient life-years. FUNDING French national research agency (INSERM) ATIP Avenir and Fondation Bettencourt Schueller.
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Affiliation(s)
- Olivier Aubert
- Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France; Kidney Transplant Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Daniel Yoo
- Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France
| | - Dina Zielinski
- Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France
| | - Emanuele Cozzi
- Transplant Immunology Unit, Department of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy; Italian National Transplant Center, Istituto Superiore di Sanità, Rome, Italy
| | - Massimo Cardillo
- Italian National Transplant Center, Istituto Superiore di Sanità, Rome, Italy
| | - Michael Dürr
- Division of Nephrology and Internal Intensive Care Medicine, Charité-Universitätsmedizin, Berlin, Germany
| | | | | | | | - Ville Sallinen
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Karl Lemström
- Department of Cardiothoracic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Karsten Midtvedt
- Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Camilo Ulloa
- Nephrology Department, Clínica Alemana de Santiago-UDD, Santiago, Chile
| | | | - Annemarie Weissenbacher
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Natalie Vallant
- Department of Transplant Surgery, Faculty of Medicine, Imperial College London, London, UK
| | - Nikolina Basic-Jukic
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | | | | | - Martin Torres
- Instituto Nacional Central Único Coordinador de Ablación e Implante (INCUCAI), Buenos Aires, Argentina
| | - Carlos Soratti
- Instituto Nacional Central Único Coordinador de Ablación e Implante (INCUCAI), Buenos Aires, Argentina
| | - Daniela Hansen Krogh
- Instituto Nacional Central Único Coordinador de Ablación e Implante (INCUCAI), Buenos Aires, Argentina
| | - Carmen Lefaucheur
- Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France; Department of Nephrology and Kidney Transplantation, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gustavo Ferreira
- Department of Medicine, Santa Casa de Juiz de Fora, Juiz de Fora, Brazil
| | - Helio Tedesco Silva
- Division of Nephrology, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - John Forsythe
- NHS Blood and Transplant, Stoke Gifford, Bristol, UK
| | - Lisa Mumford
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
| | - Peter P Reese
- Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France; Department of Medicine, Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Serge Vogelaar
- Eurotransplant International Foundation, Leiden, Netherlands
| | - Vassilios Papalois
- Department of Surgery, Faculty of Medicine, Imperial College London, London, UK
| | - Alexandre Loupy
- Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France; Kidney Transplant Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
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11
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Ribeiro Junior MAF, Costa CTK, Néder PR, Aveiro IDEA, Elias YGB, Augusto SDES. Impact of COVID-19 on the number of transplants performed in Brazil during the pandemic. Current situation. Rev Col Bras Cir 2021; 48:e20213042. [PMID: 34586206 PMCID: PMC10683411 DOI: 10.1590/0100-6991e-20213042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022] Open
Abstract
The intense use of resources to combat COVID-19 causes concern in the entire transplant community because, in addition to physical limitations such as ICU beds, lack of homogeneous treatment protocols and uncertainties about the effects of immunosuppression on viral progression have significant impact on transplant surgeries. The aim of the present study is to comparatively assess the number of solid organ transplants performed in 2019 and 2020, as well as the impact of the COVID-19 pandemic on organ donation and transplant surgeries in Brazil. The last 10 years have shown increasing trend in the number of solid organ transplants, which have significantly decreased in 2020. Lung transplantations were mostly affected by the pandemic; these surgeries have been carried out only in Rio Grande do Sul and São Paulo states. Liver transplantations were the least affected ones, since the number of surgeries have only decreased by 10.8% in the first three quarters of 2020, in comparison to 2019. The number of active patients on the waiting list for heart and kidney transplantation has increased in 2020. Therefore, it is necessary developing strategies to keep the structure necessary for organ transplantation processes active and, consequently, to reduce the impacts of the pandemic on these patients.
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Affiliation(s)
- Marcelo Augusto Fontenelle Ribeiro Junior
- - Pontifícia Universidade Católica de São Paulo - PUCSP-Sorocaba, Disciplina de Cirurgia Geral e Trauma - Sorocaba - SP - Brasil
- - Faculdade de Ciências Médicas de São José dos Campos - Humanitas - São José dos Campos - SP - Brasil
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Lauterio A, De Carlis R, Valsecchi M, Vella I, Zaniboni M, Fumagalli R, De Carlis L. Liver transplantation during the COVID-19 pandemic: A 2020 year-end report from Lombardy, northern Italy. Transpl Int 2021; 34:1984-1986. [PMID: 34148258 DOI: 10.1111/tri.13953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Lauterio
- Department of Transplantation. Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Riccardo De Carlis
- Department of Transplantation. Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mila Valsecchi
- Department of Anesthesiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Ivan Vella
- Department of Transplantation. Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Zaniboni
- Department of Anesthesiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Roberto Fumagalli
- Department of Anesthesiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Luciano De Carlis
- Department of Transplantation. Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,International Center for Digestive Health, University of Milano-Bicocca, Milan, Italy
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De Carlis R, Vella I, Incarbone N, Centonze L, Buscemi V, Lauterio A, De Carlis L. Impact of the COVID-19 pandemic on liver donation and transplantation: A review of the literature. World J Gastroenterol 2021; 27:928-938. [PMID: 33776364 PMCID: PMC7968133 DOI: 10.3748/wjg.v27.i10.928] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/01/2021] [Accepted: 02/26/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has upended healthcare systems worldwide and led to an inevitable decrease in liver transplantation (LT) activity. During the first pandemic wave, administrators and clinicians were obliged to make the difficult decision of whether to suspend or continue a life-saving procedure based on the scarce available evidence regarding the risk of transmission and mortality in immunosuppressed patients. Those centers where the activity continued or was heavily restricted were obliged to screen donors and recipients, design COVID-safe clinical pathways, and promote telehealth to prevent nosocomial transmission. Despite the ever-growing literature on COVID-19, the amount of high-quality literature on LT remains limited. This review will provide an updated view of the impact of the pandemic on LT programs worldwide. Donor and recipient screening, strategies for waitlist prioritization, and posttransplant risk of infection and mortality are discussed. Moreover, a particular focus is given to the possibility of donor-to-recipient transmission and immunosuppression management in COVID-positive recipients.
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Affiliation(s)
- Riccardo De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
| | - Ivan Vella
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
- Department of Surgical Sciences, University of Pavia, Pavia 27100, Italy
| | - Niccolò Incarbone
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan 20126, Italy
| | - Leonardo Centonze
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
| | - Vincenzo Buscemi
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
| | - Andrea Lauterio
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan 20126, Italy
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