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

Coronavirus disease 2019 (COVID-19) is a public health emergency and a pandemic of international concern.1 Italy has witnessed, in the past month, an unexpectedly high rate of infection, with more than 100 000 patients testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and a case-fatality rate close to 10% (as of March 31, 2020)2 and therefore faces a worse scenario than in China, where the disease was first reported. Data on COVID-19 in liver transplant patients are scarce. We report the experience in our transplant centre, in the midst of the current outbreak in Lombardy, Italy (10 million inhabitants; 25 124 ascertained infections, and 7199 virus-related deaths as of March 31, 2020).2 Three of our 111 long-term liver transplant survivors (transplanted more than 10 years ago) have died in the past 3 weeks (between March 5 and March 18) following severe COVID-19 disease. All three were male, older than 65 years, receiving antihypertensive drugs, overweight (BMI >28 kg/m2), with hyperlipidaemia, and diabetes (median HbA1c of 6·9%). The post-transplant course had been uneventful for all three patients, and their immunosuppressive regimen had been gradually tapered off, with very low trough concentrations of calcineurin inhibitors (two patients receiving ciclosporin [28 and 35 ng/mL, respectively] and one receiving tacrolimus [2·1 ng/mL]). All three patients died after admission to hospital for community-acquired pneumonia, and were in need of supplementary oxygen at admission but rapidly developed severe respiratory distress syndrome that required mechanical ventilation. The patients died between 3 and 12 days after the onset of pneumonia; all three patients had tested positive for SARS-CoV-2 by nasopharyngeal swabs. By contrast, three of our 40 recently transplanted (ie, within the past 2 years) patients have tested SARS-CoV-2 positive, and although quarantined, are all experiencing an uneventful course of disease.[tRUN CATED]