S1066 COVID-19 in Liver Transplant Recipients: Results of the National COVID Cohort Collaborative (N3C)

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Introduction: SARS-CoV-2 infection has resulted in significant mortality in liver transplant (LT) recipients based on available data thus far. Larger and more varied datasets are required to improve our understanding of the risks from SARS-CoV-2 faced by liver transplant recipients. The National COVID Cohort Collaborative (N3C) Enclave was developed to facilitate analysis of patient-level data across the US for multiple conditions, consisting of weekly electronic medical record data extraction and transmission into the federally secured platform. Herein is our report of the N3C cohort of US COVID-19 positive LT patients to date. Methods: We identified a cohort of LT recipients who received a positive COVID-19 test (COVID+) between 1/1/2020 and 3/30/2021. We evaluated mortality outcomes and predictive risk factors for death. We used univariate and multivariate models to analyze the variable-outcome associations. The primary outcome was in-hospital mortality. Survival analysis methods were used to estimate cumulative incidences of death and mechanical ventilation, and to calculate the associations of COVID-19 infection and demographic and clinical factors to mortality in LT patients. Results: 34 sites account for 6.3 million patients in the Enclave, of whom 2.1 million are COVID+. A total of 300 post-LT patients with COVID-19 were included in the analysis. The in-hospital mortality rate in LT COVID+ patients was approximately 7%. Hyperlipidemia, coronary artery disease (CAD) and chronic kidney disease (CKD) were common comorbidities in COVID+ LT recipients, but significantly more common in those who died. In univariate analysis, age, albumin level, CKD, CAD, hyperlipidemia, sepsis, acute kidney injury (AKI), prednisone use and mechanical ventilation were statistically significant in predicting death (p< 0.001). In multivariate analysis, only age, albumin level, prednisone use and mechanical ventilation remained statistically significant (p=0.02). Conclusion: In this study of a US cohort of COVID+ LT recipients using the N3C database, we found that mortality rate in post-LT patients with COVID-19 infection is approximately 7%. In our final predictive model, age, mechanical ventilation, and low albumin level were associated with higher risk of death. In contrast, prednisone use was associated with reduced mortality. Those factors are not only predictive, but also potentially prognostic and thus may assist with the management of COVID+ LT patients.

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