Although the incidence of COVID-19 diagnoses among post-liver transplant patients last year was lower than that of other patients in the same health care system, COVID-related mortality was higher among the transplant recipients, according to new data presented at the AASLD Clinical Science Plenary.

“At the beginning of the pandemic, there was so much uncertainty regarding the impact of COVID-19 on various populations. Given that the transplant population is likely immunosuppressed and may have other co-morbidities, we wanted to explore how the virus affected this population,” said lead study investigator Andy Tien, MD, MS, of Kaiser Permanente Medical Center in Los Angeles. “Since COVID-19 has stressed out our health care system, I think it is important to be able to identify the highest-risk populations in terms of preventative measures such as vaccinations.”

Dr. Tien and his colleagues retrospectively examined medical charts for COVID diagnoses and outcomes among 1,421 liver transplant recipients in an integrated health care system in Southern California with 4.6 million members. They found:

• The incidence of COVID before Feb. 28, 2021, among patients who underwent liver transplant before Dec. 31, 2020, was 8.2%. By comparison, almost 10% of all patients in the health care system became infected with COVID during the same time period.
• The overall mortality rate among all liver transplant recipients, regardless of COVID status, was nearly 3%.
• The overall case-fatality rate among COVID-infected liver transplant recipients was about 8%. However, the overall case-fatality rate among all COVID-positive patients in the integrated health care system was a little over 1%.
• Of liver transplant recipients hospitalized for COVID, more than 20% required intubation and intensive care unit services. The mortality rate among these patients was 75%.

“This highlights a high-risk population that may succumb to COVID-19, and I hope that attendees will go back to their clinic and make sure that all of their post-transplant patients receive the COVID-19 vaccine and continue to exercise caution to prevent the disease,” said Dr. Tien. “Moreover, when these patients present to the ED with COVID-19 symptoms, it’s important in triaging them that providers have a lower threshold to initiate treatments and provide closer monitoring.”

Dr. Tien added that the field could benefit from additional research to assess outcomes in this population after vaccination, considering that they are immunosuppressed when they receive the vaccination. Data that delve into socioeconomic factors to look for any associated health disparities in outcomes would also be beneficial, he said.

“We hope that patients become more aware of the serious effects that this virus, and potentially future pandemics, has on their health. We hope that all of them become vaccinated to avoid serious disease,” he said. “As a result, we also hope that the hospitalizations and mortality decrease with more health education.”

Dr. Tien’s oral presentation of “Incidence and mortality of COVID-19 in post-liver transplant patients in a large integrated healthcare system” took place on Saturday, May 22, at 1 p.m. EDT, as part of the AASLD Clinical Science Plenary.