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Does Covid-19 Infection Significantly Affect Liver Transplantation? Results of Liver Transplantation in the Covid-19 Era at a Single, High-Volume Centre Publisher



Moradi A1, 2 ; Hadizadeh A3 ; Ghiasvand F4 ; Ahmadinejad Z4 ; Toosi MN5 ; Ghazi S6 ; Jafarian A1, 2 ; Ahmaditafti M2, 7 ; Ayati A3
Authors
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Authors Affiliations
  1. 1. Liver Transplant Research Center, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Tropical and Infectious Diseases, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Anesthesia and Critical Care, Tehran University of Medical Sciences, Tehran, Iran
  7. 7. Colorectal Surgery Research Center, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

Source: BMJ Open Gastroenterology Published:2023


Abstract

Background Liver transplantation is a proven management method for end-stage cirrhosis and is estimated to have increased life expectancy by 15 years. The COVID-19 pandemic posed a challenge to patients who were candid for a solid-organ transplant. It has been suggested that the outcomes of liver transplants could be adversely affected by the infection, as immunosuppression makes liver transplant candidates more susceptible to adverse effects while predisposing them to higher thrombotic events. Material and methods In this retrospective study, the cases who received liver transplants from January 2018 to March 2022 were assessed regarding early postoperative mortality rate and hepatic artery thrombosis (HAT) with COVID-19 infection. This study included 614 cases, of which 48 patients were infected. Results This study shows that the early COVID-19-related early postoperative mortality rates substantially increased in the elective setting (OR: 2.697), but the results for the acute liver failure were insignificant. The average model for end-stage liver disease score increased significantly during the pandemic due to new regulations. Although mortality rates increased during the pandemic, the data for the vaccination period show that mortality rates have equalised with the prepandemic era. Meanwhile, COVID-19 infection is assumed to have increased HAT by 1.6 times in the elective setting. Conclusion This study shows that COVID-19 infection in an acute liver failure poses comparatively little risk; hence transplantation should be considered in such cases. Meanwhile, the hypercoagulative state induced by the infection predisposes this group of patients to higher HAT rates. © 2023 BMJ Publishing Group. All rights reserved.
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