Clinical Presentation, Treatment and Mortality Rate in Liver Transplant Recipients with COVID-19: A Systematic Review & Quantitative Analysis

Abstract Liver transplant(LT) recipients may be at increased risk of adverse outcomes with coronavirus disease 2019(COVID-19) infection due to chronic immunosuppression and associated comorbidities. There is a paucity of literature describing clinical presentation, treatments and outcomes in LT recipients with COVID-19. A systematic search was performed for articles published up to June 15, 2020, revealing 223 LT recipients with COVID-19 in 15 studies. Patients most commonly presented with fever(66.7%), dyspnea(34.0%), diarrhea(28.4%). 77.7% required hospitalization, 24% had mild disease, 40% had moderate, and 36% had severe disease. Immunosuppression was modified in 32.8% of recipients. Case fatality rate was 19.3%. Dyspnea on presentation, diabetes mellitus and age ≥60 years were significantly associated with increased mortality(p≤0.01) with a trend to higher mortality rate observed in those with hypertension, and those receiving steroids at the time of COVID-19 diagnosis. The median time from symptoms to death was 11.5 days(2-45). In conclusion, LT recipients with SARS-CoV-2 are overrepresented with regards to severe disease and hospitalizations. Older LT patients with diabetes mellitus or hypertension, on maintenance steroids, with a diagnosis of COVID-19 describing breathlessness should be aggressively monitored for signs of deterioration due to risk of mortality.