key: cord-0828144-qajk0ov4
authors: Mocchegiani, Federico; Baroni, Gianluca Svegliati; Vivarelli, Marco
title: Mild impact of SARS-CoV-2 infection on the entire population of liver transplant recipients: the experience of an Italian Centre based in a high-risk area
date: 2020-09-10
journal: Updates Surg
DOI: 10.1007/s13304-020-00881-9
sha: 271970204df0056f6043b9635755b5646fe88867
doc_id: 828144
cord_uid: qajk0ov4

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pneumonia were detected at the chest X-ray. On admission, blood chemistry tests were as follows: aspartate aminotransferase 84 U/dl, alanine aminotransferase 30 IU/dl, Bilirubin 1.4 mg/dL, gamma-glutamyl transpeptidase 262 IU/L, creatinine 1.16 mg/dL. The patient died on the same day, soon after admission to the Intensive Care Unit.

The other two patients with a positive swab confirmed COVID 19 experienced mild disease with a single episode of fever and cough for one week. The immunosuppressive regime was a combination of TAC with Mycophenolate or Everolimus. Both patients had a normal liver function and were treated with Hydrossichlorochyne.

On 26 of these 36 (72.2%) "suspected cases", we performed serological tests to detect anti-SARS-CoV-2 antibodies and no positivity for IgM and/or IgG was detected. Globally, in our population of LTRs, rate of SARS-CoV-2 infection and mortality were 0.87 and 0.29% respectively versus 0.44% and 0.06% of the general population in Marche region [1] .

During the COVID 19 outbreak, only other three Italian liver transplant centres reported their experience: Bergamo, Istituto Tumori Milan and Ospedale Maggiore Ca' Granda Policlinico Milan. D'Antiga et al. reported 200 LTRs with 3 tested positive patients for SARS-CoV-2, none developed a clinical pulmonary disease [3] . Bhoori et al. reported three deaths among 111 long-term adult liver transplant survivors (transplanted more than 10 years ago) following severe COVID-19 while 3 of 40 recently transplanted (ie, within the past 2 years) patients who were found SARS-CoV-2 positive experienced an uneventful course of the disease [4] . Donato et al. reported an incidence of confirmed COVID-19 infection of 1.25% in the population of LTRs of one Milan transplant centre of whom none developed such a severe disease to require invasive ventilation [5] .

During the outbreak of COVID-19, in Marche region the infection rate of SARS-Cov-2 has been of 0.44% [1], similar to that observed in our LTRs population. A possible explanation of this mild impact of COVID-19 on LTRs is the relatively low mean age (55 years) and low exposure to immunosuppressant agents in the context of modern minimization protocols. Self-isolation either spontaneous or induced by the lockdown, imposed by the Italian Government in the early phase of the epidemia, may have also helped in limiting the spread of the infection.

Whereas the available literature has been mainly focused on describing those cases that had a poor outcome or a severe disease, the major point of strength of the present report is that a thorough investigation on the health status of all LTRs was carried out, and this minimizes the possibility of underestimation of the actual impact of SARS-COV-2 infection in this particular population.

We acknowledge that this LTRs series has some limitations, such as the small sample size and the necessity of further studies to achieve solid results and conclusions. However, according to our observation, we suggest that for liver transplant recipients, the risk of acquiring SARS-CoV-2 infection and, in particular, of developing COVID-19 is not as remarkably high as it could have been hypothesized.

Funding None.

Ethical approval This study was approved by our Ethics Comitee: Approval number 175 and protocol number 1516.

Informed consent In the present study, informed consent was obtained from medical personnel for each patients prior to any telephone or in-person interview. All informed consents are stored in paper form in our archive.

Coronaviruses and immunosuppressed patients. The facts during the third epidemic

COVID-19 in long-term liver transplant patients: preliminary experience from an Italian transplant centre in Lombardy

2020) health status of liver transplanted patients during the coronavirus outbreak in Italy: a large single center experience from Milan