Mild impact of SARS-CoV-2 infection on the entire population of liver transplant recipients: the experience of an Italia
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LETTER TO THE EDITOR
Mild impact of SARS‑CoV‑2 infection on the entire population of liver transplant recipients: the experience of an Italian Centre based in a high‑risk area Federico Mocchegiani1 · Gianluca Svegliati Baroni2 · Marco Vivarelli1 Received: 26 August 2020 / Accepted: 1 September 2020 © Italian Society of Surgery (SIC) 2020
Keywords Covid 19 · SARS-CoV-2 · Liver transplant · Questionnaire · Immunosuppression SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) outbreak ravaged Italy. Marche is the eight Italian region in terms of rate of disease [1]. Several cases of Coronavirus Disease 19 (COVID 19) in liver transplant recipients (LTRs) have been reported but there is no figure on the prevalence of the disease in the entire population of LTRs. We investigated the clinical status of all currently alive LTRs transplanted in Ancona, a single centre based in a high-incidence area, between January 1, 2005 and March 31, 2020 (Table 1). Starting with a phone interview, we updated the clinical status focusing on symptoms related to COVID19 and further assessed. Among the 343 LTRs, 3 suffered from SARS-CoV-2 infection confirmed by nasopharyngeal swab and 36 were classified as “suspected cases” for COVID 19 symptoms with a negative swab, according to World Health Organization guidelines [2]. Only one patient suffered from a severe infection. A 60-year-old male, liver transplantation 7 years earlier for a HCV-related cirrhosis, with no comorbidity, Body Mass Index 25 and immunosuppressed with Tacrolimus (TAC) monotherapy (blood level: 4.5 ng/mL). Forty days earlier, the patient had experienced fever, dry cough and diarrhea, which lasted for about 10 days and was treated with paracetamol alone. Due to the development of difficulty in breathing, he had been transferred to a peripheral hospital where radiological findings of bilateral severe interstitial * Federico Mocchegiani [email protected] 1
HPB and Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Via Tronto 10/a, 60126 Ancona, Italy
Clinic of Gastroenterology, Department of Medical and Surgical Sciences, Polytechnic University of Marche, Ancona, Italy
2
pneumonia were detected at the chest X-ray. On admission, blood chemistry tests were as follows: aspartate aminotransferase 84 U/dl, alanine aminotransferase 30 IU/dl, Bilirubin 1.4 mg/dL, gamma-glutamyl transpeptidase 262 IU/L, creatinine 1.16 mg/dL. The patient died on the same day, soon after admission to the Intensive Care Unit. The other two patients with a positive swab confirmed COVID 19 experienced mild disease with a single episode of fever and cough for one week. The immunosuppressive regime was a combination of TAC with Mycophenolate or Everolimus. Both patients had a normal liver function and were treated with Hydrossichlorochyne. On 26 of these 36 (72.2%) “suspected cases”, we performed serological tests to detect anti-SARS-CoV-2 antibodies and no positivity for IgM and/or IgG was detected. Globally,
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