The COVID-19 infection in liver transplant recipients: A Cohort Study

Research Article                

American Journal of BioMedicine                  Open-Access Publishing | Gitter-Smolarz Library of <br>Life Sciences and Medicine | Tel Aviv University

Volume 12, Issue 1, 2024, Pages 1-10    10.18081/2333-5106/2024.12/1

Arif Munawar 1 , Naila Moin , Sara Sarwar *

Received 22 August 2023; revised 17 October 2023; accepted 04 December 2023; published 15 January 2024


The immunosuppressed state of liver transplant recipients makes them vulnerable to infections after surgery. These infections are directly correlated with the net state of immunosuppression. Higher levels of immunosuppression mean a higher risk of infection, with rates of infection typically highest in the early post-transplant period. Coronavirus disease 2019 (COVID‐19) vaccines have shown efficacy in generating specific immune responses. This study aims to describe the COVID-19 infection before and after vaccination in liver recipients. This was a cohort study including 77 liver transplant recipients with laboratory radiological confirmed COVID-19. COVID-19 infection was present before vaccination in 30 patients. The most frequent COVID-19 clinical presentations before vaccination were cough in 32 patients and myalgia in 21 patients; 27 cases had oxygen depletion and required supplemental oxygen. Of the 30 COVID-19 patients, 4 patients re-experienced the disease about three months after complete vaccination. 33 liver transplant patients had not experienced COVID-19 before vaccination, of which 32 patients received vaccination. In conclusion, liver transplant patients infected with SARS-CoV-2 are at greater risk of severe infection and death compared with immunocompetent individuals. Thus, COVID-19 vaccination for all liver recipients is of paramount importance.

Keywords: Liver transplant; COVID-19; Cohort Study

Copyright © 2024 Sarwar et al. This article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cited by other articlesReferencesStatistics
The citation data is computed by the following citation measuring services:Google Scholar
Cited by CrossRef (1)
Cited by Scopus (0)

1. Oyelade T, Alqahtani J, Canciani G. Prognosis of COVID-19 in patients with liver and kidney diseases: an early systematic review and meta-analysis. Trop Med Infect Dis. 2020;5(2).
2. Mokdad AA, Lopez AD, Shahraz S, et al. Liver cirrhosis mortality in 187 countries between 1980 and 2010: A systematic analysis. BMC Med. 2014;12:145.
3. Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J. Hepatol. 2019;70:151-171.
4. Kottgen A, Glazer NL, Dehghan A, et al. Multiple loci associated with indices of renal function and chronic kidney disease. Nat. Genet. 2009;41:712-717.
5. Suleymanlar G, Utas C, Arinsoy T. et al. A population-based survey of Chronic REnal Disease In Turke-The CREDIT study. Nephrol. Dial. Transplant. 2011;26:1862-1871.
6. Hashemi N, Viveiros K, Redd WD, et al. Impact of chronic liver disease on outcomes of hospitalized patients with COVID-19: a multicentre United States experience. Liver Int. 2020;40(10):2515-2521.
7. Qi X, Liu Y, Wang J, et al. COVID-Cirrhosis-CHESS Group Clinical course and risk factors for mortality of COVID-19 patients with pre-existing cirrhosis: a multicentre cohort study. Gut. 2021;70(2):433-436.
8. Fan Z, Chen L, Li J, Cheng X, Yang J, Tian C, Zhang Y, Huang S, Liu Z, Cheng J. Clinical features of COVID-19-related liver functional abnormality. Clin Gastroenterol Hepatol. 2020;18(7):1561-1566.
9. Phipps MM, Barraza LH, LaSota ED, et al. Acute liver injury in COVID-19: prevalence and association with clinical outcomes in a large US cohort. Hepatology. 2020;72:807-817.
10. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323(20):2052-2059.
11. Goyal P, Choi JJ, Pinheiro LC,et al. Clinical characteristics of Covid-19 in New York City. N Engl J Med. 2020;382(24):2372-2374.
12. Pereira MR, Antinori S, Cossu MV, et al. Compassionate remdesivir treatment of severe Covid-19 pneumonia in intensive care unit (ICU) and Non-ICU patients: clinical outcome and differences in post-treatment hospitalisation status. Pharmacol Res. 2020;158:104899.
13. Aversa MM, Farr MA, Miko BA, et al. Tocilizumab for severe COVID-19 in solid organ transplant recipients: a matched cohort study. Am J Transplant. 2020;20(11):3198-205.
14. Montastruc F, Thuriot S, Durrieu G. Hepatic disorders with the use of remdesivir for coronavirus 2019. Clin Gastroenterol Hepatol. 2020;18(12):2835-2836.
15. Laracy JC, Verna EC, Pereira MR. Antivirals for COVID-19 in solid organ transplant recipients. Curr Transplant Rep. 2020:1-11.
16. Neidlinger NA, Smith JA, D'Alessandro AM, et al. Organ recovery from deceased donors with prior COVID-19: a case series. Transpl Infect Dis. 2020:e13503.
17. Niess H, Borner N, Muenchhoff M, et al. Liver transplantation in a patient after COVID-19-rapid loss of antibodies and prolonged viral RNA shedding. Am J Transplant. 2021;21(4):1629-1632.
18. Zhang C, Shi L, Wang F-S. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol 2020;5:428-30.
19. Gacouin A, Locufier M, Uhel F, et al. Liver cirrhosis is independently associated with 90-day mortality in ARDS patients. Shock 2016;45:16-21.
20. Jepsen P, Vilstrup H, Andersen PK, et al. Comorbidity and survival of Danish cirrhosis patients: a nationwide population-based cohort study. Hepatology 2008;48:214-20.
21. Rabinowich L, Grupper A, Baruch R, et al. Low immunogenicity to SARS-CoV-2 vaccination among liver transplant recipients. J Hepatol. 2021;75:435-438.
22. Ruether DF, Schaub GM, Duengelhoef PM, et al. SARS-CoV2-specific humoral and T-cell immune response after second vaccination in liver cirrhosis and transplant patients. Clin Gastroenterol Hepatol. 2022;20:162-172.
23. Levin MJ, Ustianowski A, De Wit S, et al. PROVENT Study Group. Intramuscular AZD7442 (Tixagevimab-Cilgavimab) for prevention of Covid-19. N Engl J Med. 2022;386:2188-2200.
24. Al Jurdi A, Morena L, Cote M, Bethea E, Azzi J, Riella LV. Tixagevimab/cilgavimab pre-exposure prophylaxis is associated with lower breakthrough infection risk in vaccinated solid organ transplant recipients during the omicron wave. Am J Transplant. 2022;22:3130-3136.
25. Shah VK, Firmal P, Alam A, Ganguly D, Chattopadhyay S. Overview of immune response during SARS-CoV-2 infection:lessons from the past. Front Immunol. 2020;11:1949.
26. Timsit JF, Sonneville R, Kalil AC, et al. Diagnostic and therapeutic approach to infectious diseases in solid organ transplant recipients. Intensive Care Med. 2019;45:573-591.
27. Colmenero J, Rodríguez-Perálvarez M, Salcedo M, et al. Epidemiological pattern, incidence, and outcomes of COVID-19 in liver transplant patients. J Hepatol. 2021;74:148-155.
28. Webb GJ, Marjot T, Cook JA, et al. Outcomes following SARS-CoV-2 infection in liver transplant recipients:an international registry study. Lancet Gastroenterol Hepatol. 2020;5:1008-1016
29. Fraser J, Mousley J, Testro A, Smibert OC, Koshy AN. Clinical presentation, treatment, and mortality rate in liver transplant recipients with coronavirus disease 2019:a systematic review and quantitative analysis. Transplant Proc. 2020;52:2676-2683.
30. Huang JF, Zheng KI, George J, et al. Fatal outcome in a liver transplant recipient with COVID-19. Am J Transplant. 2020;20:1907-1910.
31. Yousif NG, Fullerton J, Cabrera V. Special considerations for leukemic patients during the COVID-19 pandemic: meta-analysis study. NeuroQuantology. 2022;20(8): 7509-7515.
32. Mohammed A, Paranji N, Chen PH, Niu B. COVID-19 in chronic liver disease and liver transplantation:a clinical review. J Clin Gastroenterol. 2021;55:187-194.
33. Elens L, Langman LJ, Hesselink DA, et al. Pharmacologic treatment of transplant recipients infected with SARS-CoV-2:considerations regarding therapeutic drug monitoring and drug-drug interactions. Ther Drug Monit. 2020;42:360-368.
34. AL-Hussein AJ, Alruda GM, Yousif NG, Increased neutrophil-lymphocyte ratio in patients with COPD: case-control study. American Journal of Biomedicine. 2023;11(3): 144-157.

File and statistics


How to cite

Munawar A, Moin N, Sarwar S. The COVID-19 infection in liver transplant recipients: A Cohort Study. American Journal of BioMedicine 2024; 12(1):1-10.

More Citation

Arif Munawar, Sara Sarwar, Naila Moin, Sara Sarwar. (2024, January 15). The COVID-19 infection in liver transplant recipients: A Cohort Study. Retrieved March 8, 2024, from website:
Arif Munawar, Sara Sarwar, Naila Moin, Sara Sarwar. “The COVID-19 Infection in Liver Transplant Recipients: A Cohort Study.”, 15 Jan. 2024,
Arif Munawar, Sara Sarwar, Naila Moin, Sara Sarwar (2024) The COVID-19 infection in liver transplant recipients: A Cohort Available at: (Accessed: March 8, 2024).
Arif Munawar, Sara Sarwar, Naila Moin, Sara Sarwar. The COVID-19 infection in liver transplant recipients: A Cohort Study [Internet]. 2024 [cited 2024 Mar 8]. Available from:

Article Metrics


Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

All articles published in American Journal of BioMedicine  are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.