Background and Aims: Liver transplant (LT) recipients are vulnerable to SARS-CoV-2-infection (COVID-19), due to immunosuppression and comorbidities. This study aimed to evaluate the impact of COVID-19 on LT recipients compared to general population in the Campania region. Methods: : In this case-control double-centre study, we enrolled all consecutive adult LT recipients with confirmed SARS-CoV-2-infection. Data were collected at diagnosis of COVID-19 and during follow-up and compared with the regional population. Results: : Thirty LT recipients (3.28%) developed SARS-CoV-2-infection (76.6% male, median age 62.6 years). Sixteen (53.3%) were symptomatic. Common symptoms were fever, cough, fatigue, and anosmia. Twenty-five (83.4%) were outpatients, 5 (16.6%) required hospitalization (6.6% admitted to Intensive Care Unit, 6.6% developed Acute Respiratory Distress Syndrome and 6.6% died). Immunosuppressors were in 3 (10%) patients. Incidence rate of COVID-19 was similar between LT patients and general population (3.28% vs 4.37%, p=0.1) with higher rate of symptoms in LT patients (46.67% vs 15.87%, p<0.00). At univariate analysis, hospitalization and case fatality rates were higher in LT patients compared to general population (16.67% vs 4.54%, p=0.001;and 6.67% vs 1.76%, p=0.04, respectively). At multivariable logistic regression analysis, LT patients with COVID-19 were more frequently symptomatic (OR 5.44 [95%CI 2.44-12.17], p<0.00), whereas hospitalization and death for COVID-19 were not significatively associated with LT condition (p=0.72 and p=0.46, respectively) and were comparable with general population. Conclusions: : LT is not a risk factor for acquiring COVID-19. Nonetheless, LT patients are more frequently symptomatic, although comparable to the general population for hospitalization rate and mortality.
Covid-19 in Liver Transplant Recipients: An Italian Case-Control Double-Centre Study