COVID-19 in liver transplant recipients: How big is the problem?

Background: In December 2019, a new contagious disease, named COVID-19 caused by a novel coronavirus (SARSCov- 2) emerged in Wuhan City, China Since February 2020 this disease has also spread to Italy Bergamo, where one of the most active liver transplant (LT) Italian center is located, has been one of the most affected cities by COVID-19 This study aimed to evaluate the impact of COVID-19 in liver transplant patients Methods: From April 1st, 2020, to May 15th, 2020, 660 adult liver transplant recipients were contacted by phone by the medical staff of the Transplant Center at the ASST-Papa Giovanni XXIII-Bergamo The presence of COVID-19 symptoms (fever, cough, dyspnea, asthenia, dysgeusia, anosmia, gastrointestinal complaints and/or myalgia) and contact at risk were investigated Results of RX chest, SARS-Cov-2 nose-swab and hospitalizations, when occurred, were recorded in symptomatic patients Results: Seventy-seven patients (11 7%) reported symptoms related to SARS-Cov-2 infection;patients were primarily males (72 7%), with a median age of 62 9 years (IQR 57 1-69 0) and a median time from LT of 73 6 months (IQR 36 5-135 8) A chest x-rays was performed in 25/77 symptomatic patients (32 5%) and in 17/25 (68 0%) an interstitial pneumonia was found;swabs were performed in 21/77 patients (27 3%) and 17 of them (81 0%) resulted positive Among symptomatic patients, all reported at least two symptoms and in 14 (18 2%) five symptoms were present Three patients (3 9%) had been hospitalized for transplant-related reasons and 11 patients needed hospitalization because of COVID-19 (14 9%) All hospitalized patients were treated with antibiotics;high dose steroids were added to 8 patients and antiviral therapy (lopinavir/ritonavir) to 4 patients Nine patients (11 7%) needed oxygen therapy One patient died for non-COVID-19 related condition, 2 patients died for COVID-19 (2/76;2 6%) Mortality in hospitalized patients was 21 4% (3/14), COVIDrelated mortality-rate was 15 4% (2/13) and both patients died within one month after LT Conclusion: COVID-19 can affect liver transplant patients, however, in our experience, both the need for hospitalization and deaths do not exceed those observed among the general population