Introduction
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a virus belonging to the Orthocoronavirinae subfamily, first identified in Wuhan, Hubei Province, China, in December 2019.1 Infection with SARS-CoV-2 is responsible for a clinical condition, named COVID-19, which ranges from mild respiratory and/or GI symptoms to interstitial pneumonia with acute respiratory distress syndrome (ARDS), diffuse thrombotic and thromboembolic disease,2 multiorgan failure (MOF) and even death with a case fatality rate ranging from 5.65%3 to 15%,4 5 with high geographical heterogeneity. The outbreak of SARS-CoV-2 infection, declared pandemic on 11 March 2020 by the WHO,6 has rapidly become a public health matter with several unmet issues. To date, firm knowledge on disease evolution, risk factors, clinical manifestations and optimal management are lacking, particularly in specific categories of patients. In the setting of solid organ transplantation, and particularly liver transplant recipients, information on natural history of COVID-19 are limited to expert statements,7 8 case reports9 and small case series.10 11 Concerns have been raised about immunosuppression therapy, and it is still unknown whether the latter actually represents an increased risk for more severe illness, including higher risk of bacterial coinfection,12 13 or not. In this view, previous experience with similar viruses, such as SARS-CoV in 200314 and MERS-CoV in 2015,15 suggests that solid organ recipients would be prone to have increased morbidity.16 However, in these cases, sample size and data quality did not allow definitive conclusion. Moreover, recent evidence has shown SARS-CoV-2 associated liver injury,17–19 which might per se impair the prognosis of liver transplant patients with COVID-19. Overall, liver transplant patients are a population with multiple potential risk factors for poorer outcome that need to be investigated in detail.
This study describes the demographics, baseline clinical characteristics and early outcomes of a European cohort of liver transplant recipients with SARS-CoV-2 confirmed infection during the first outbreak of COVID-19 pandemic.