key: cord-0699586-l8dw99sc
authors: Mansoor, Emad; Sclair, Seth S.; Cooper, Gregory S.
title: Letter to the Editor: Characteristics of Liver Transplant Patients Admitted with COVID-19
date: 2021-05-18
journal: Gastroenterology
DOI: 10.1053/j.gastro.2021.05.029
sha: 2d71788550c99c1e6fd89dd80a63c1456ba90e25
doc_id: 699586
cord_uid: l8dw99sc

nan

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Emad Mansoor diagnosis and presentation to address this. We did not have data on access of patients in our study to adequate telemedicine care.

With regards to the relatively lower mortality of LT COVID-19 patients in our study (8%) compared to the 17%-19% in hospitalized patients (4, 5) in other studies, we would like to highlight that the control arm in our group comprised on patients with COVID-19 and without LT also had a relatively lower mortality rates (4%) compared to the control arms of the aforementioned studies. This potentially could be explained by relative differences in geographic distribution patterns of COVID-19, differences in prevalence, infectivity and transmission rates and potentially presences of different strains as well. We agree that this could also be explained by patients in the LT COVID-19 group with mild as opposed to severe disease being admitted due to lower threshold for admission.

We also welcome the data shared by Regmi and colleagues on their single-arm meta-analysis of studies from Europe, Spain and our study where they found a similar order of presenting symptoms in patients with COVID-19 and LT. While they found that a higher proportion of patients with COVID-19 and LT were hospitalized, they did not find a significant difference in proportion of individuals requiring ICU care and in mortality. Our lower rate of hospitalization compared to the European experience likely suggests earlier presentation and/or diagnosis in our patients. The differences in rates of hospitalization may be due to relative differences in COVID-19 epidemiology as well as differences in thresholds for hospitalization at institution-level. In addition, it should be noted that ICU requirement in our study was defined as requiring mechanical ventilation or ECMO, whereas in other studies the definitions were more liberal, thereby leading to a potential lower estimate of ICU requirement in our study.

Moreover, other factors including earlier presentation and/or diagnosis in our LT patients, more aggressive testing given LT status and increased accessibility to a multidisciplinary post LT team may explain a decreased risk of progression to severe disease, and consequently decreased rates of hospitalization in our study.

Our study did have some limitations which include retrospective nature, inaccessibility to treatment regimens, if any, for patients with COVID-19 and other information unavailable in the TriNetX database. Further prospective studies are needed to make any definitive conclusions regarding long-term outcomes of LT patients with COVID-19 and to develop immunosuppression protocols in LT patients with COVID-19.

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