Impact of COVID-19 on liver transplantation in Europe: Alert from an early survey of European Liver and Intestine Transplantation Association (ELITA) and European Liver Transplant Registry (ELTR).

There are scarce data on the impact of COVID-19 pandemic on liver transplantation (LT) in Europe. The aim of this study was to obtain a preliminary data on incidence, management and outcome of COVID-19 in liver transplant recipients and candidates in Europe. An internet-based survey was sent to the centers affiliated with ELTR. 109 out of 149 (73%) of ELTR centers located in 28 European countries (93%) responded. 94 (86%) of the centers tested all donors and 75 (69%) centers tested all LT recipients for SARS-Cov-2. 73 (67%) centers selected recipients for LT in the COVID-19 pandemic, whereas 33% did not. Eighty-eight centers reported COVID-19 infection in 57 LT candidates and in 272 LT recipients. Overall crude incidence of COVID-19 among LT candidates and recipients was estimated 1.05 % (range 0.5%-20% and 0.34% (range 0.1%-4.8%), respectively and it was significantly higher among candidates (p<0.001). Crude rate of death was 18% (10/57) among candidates and 15% (36/244) among recipients. This first large-scale European snapshot study clearly shows that both LT candidates and recipients are at a high risk for COVID-19. These results plead for an early and pro-active screening of COVID-19 symptoms in these populations.