COVID-19 Diagnosis Increases Hospitalization Risk in People With Liver Transplant

Although hospitalization risk was higher, mortality, thrombosis, and ICU admission risks were the same in patients with and without liver transplants.

Liver transplant patients with coronavirus disease 2019 (COVID-19) have a significantly higher risk for hospitalization but not for mortality, thrombosis, or intensive care unit (ICU) requirement, compared with patients with COVID-19 but without a liver transplant, according to a published study in Gastroenterology.

Investigators used the TriNetX health research network to obtain electronic medical records of adult liver transplant recipients (aged ≥18 years) with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (LT group) from 35 health care organizations in the United States from January 1, 2020, to June 23, 2020. They also searched for patients who were COVID-19–positive with no history of liver transplant (non-LT group).

A total of 43,508 non-LT patients with COVID-19 and 126 LT patients with COVID-19 patients were identified. After 1:1 propensity score matching (PSM), the 2 groups were relatively balanced regarding demographic characteristics: LT group (n=125; age, 57.03±13.32; 34% women) and non-LT group (n125; age, 59.83±14.71; 32% women).

The researchers found that patients in the LT group had a significantly higher risk for hospitalization compared with the non-LT group both before and after PSM. After PSM, in the adjusted analysis, 40% of patients in the LT group required hospitalization compared with 23% of patients in the non-LT group (risk ratio [RR], 1.72, P <.0043).

The unadjusted analyses showed that the risks of mortality (RR, 2.27, P =.0069), thrombosis (RR, 3.55, P <.0001), and ICU requirement (RR, 2.64, P =.0013) were higher in the LT group compared with the non-LT group. After PSM, however, no differences were observed in the risks of mortality, thrombosis, and ICU requirement between the 2 groups.

Study limitations include the retrospective design and the inaccessibility to treatment regimens, if any, for patients with COVID-19, as well as other information unavailable in the database, including socioeconomic status, exposure history, and geographic data of the patients.

“We found LT patients with COVID-19 to have significantly higher risk of hospitalization but not mortality, thrombosis, or ICU requirement compared to patients without LT and COVID19, when matched for severity of illness,” the researchers concluded. “Given the limitations and retrospective nature of this study, further prospective studies are needed to evaluate the burden of care in LT patients and long-term outcomes of LT patients with COVID-19.”


Mansoor E, Perez A, Abou-Saleh M, et al. Clinical characteristics, hospitalization and mortality rates of COVID-19 among liver transplant patients in the United States: a multi-center research network study. Published online September 30, 2020. Gastroenterology. doi: 10.1053/j.gastro.2020.09.033