Liver transplantations, graft survival decreased during COVID-19 pandemic

Early in the COVID-19 era, liver transplantation decreased overall with a lower graft survival at 90-day post-transplantation and higher organ rejection rate, according to a presentation at The Liver Meeting Digital Experience.

“Graft survival and patient survival at 90 days post-transplantation was lower during the COVID period,” Kenji Okumura, MD, of the department of surgery at the New York Medical College/Westchester Medical Center in Valhalla, said during the presentation. “The difference was much more pronounced after 30 days post-transplantation.”

Okumura and colleagues retrospectively assessed data from the United Network for Organ Sharing (UNOS) on outcomes in adult liver transplant recipients during the COVID period (March 11- Sept. 11, 2020) and compared them to a pre-COVID period (March 11- Sept. 11, 2019). Additionally, the COVID period occurred simultaneously with change in the national liver organ allocation system from February 2020.

Investigators found overall during the COVID period, 4% fewer liver transplantations were performed compared with the pre-COVID period (4,107 vs. 4,277). This was most notable during the months of March to April; whereas there was a rebound in numbers noted from May to July. In the United Network for Organ Sharing regions 1, 2, 3, 5, 6 and 8, the total number of liver transplantations performed decreased, with a paradoxical increase in regions 7, 9, 10 and 11.

The number of living donor liver transplants, median recipient age, recipient gender ratio and median BMI remained the same in the COVID period compared with the pre-COVID period.

According to Okumura, the most common primary diagnosis during the COVID period with an increase from the pre-COVID period was alcoholic liver disease (1,315 vs. 1,187; P < .01). Liver transplant recipients had higher median MELD scores (25 vs. 23; P < .01), lower waiting list time (52 days vs. 84 days; P < .01), higher need for hemodialysis before transplant (457 vs. 404; P = .012) and higher rate of multi-organ transplant (475 vs. 402; P = .074) in the COVID period. Although the donor age and gender ratio remained the same, the donor risk index was higher in the COVID period (1.65 vs. 1.55; P < .01). In the COVID era, the distance between the donor and recipient hospital was farther (131 miles vs. 64 miles; P < .01).

“As programs attempted to pre-emptively lower overall immunosuppression during the COVID period, rejection episodes before discharge were higher (4.6% vs 3.4%; P = .023). COVID-19 was the primary cause of death in five out of 155 (3.2%) of total deaths in patients who were transplanted during the COVID period,” Okumura and colleagues wrote in the abstract.

Okumura noted the COVID period was an independent factor for graft failure, according to results from the multivariable Cox regression analysis for graft survival at 90 days (HR = 1.77; P < .01).