Introduction: Amid the COVID-19 pandemic, the consequences of infection by the SARS-CoV 2 virus in Liver Transplant recipients (LT) patients is of particular concern, notably due to the perceived added risk of these patients related to immunosuppression and comorbidity burden. Current literature on this topic often uses small, non-standardized, and ethnically limited samples. This study describes COVID-19 presentation and complications in a large, multicentric, and ethnically diverse population of LT recipients. Methods: We designed this study as a multi-centric historical cohort, analyzing patient records submitted by an online questionnaire. The study included LT recipient patients with suspected or confirmed COVID-19 already in follow-up at the study centers. The primary endpoint was COVID-related death. We also collected demographic, clinical, and laboratory data regarding presentation and disease progression. Results: We included 314 patients from 25 participant centers in Brazil. It is, to our knowledge, the largest current cohort of LT recipients with COVID-19. The median age was 60 years old (IQR: 53-66), and the hospitalization rate was 56%, with an overall mortality rate of 17,9%. Patients were mostly male (66%), white (59%), and overweight, with a median BMI of 27 (IQR 24-32). The median follow-up time was 117 days (IQR 41,291). The two most prevalent comorbidities were hypertension (N= 138 - 48%) and diabetes (N= 129 - 45%). Increased mortality was associated with fewer years from transplantation (p=0.03), increased BMI (p=0.02), the presence of dyspnea (p<0.001), and lost sense of smell (p=0.01) at presentation, and alterations to immunosuppression after admission (p<0.001). The use of mycophenolate at admission was also associated with increased mortality (p=0.02). Liver function test results were not associated with mortality. Median time from admission to death was 22 days (IQR: 12-35). Conclusion: This large, multicentric study suggests novel risk factors for mortality not previously reported in other studies - notably the use of Mycophenolate and fewer years from transplantation. As such, the results of this study are paramount to the comprehensive and individualized treatment of this multifaceted patient population and stand as a stepping stone for further understanding of the disease presentation in these patients. Regina G Santos, Laura CM Pinto, Simone R Peralles, Leticia Zanaga, Rita CMF Silva, Luiz AC Dalbuquerque, Renata Ferreira Bezerra, Marcelo Nogara, Huda M Noujam, Agnaldo S Lima, Ana F Passos, Ivelise RC Brasil, Renato Hidalgo, Christian E Garcia, Ajith K Sankarankutty, Adriano M Gonzales, Andre I David, Mauricio Barros, Ben-Hur E Ferraz-Neto, Claudemiro Quireze-Júnior, Eduardo Fonseca.

The Covid-19 epidemiological profile of disease presented two main waves in the world as well as in Brazil between 2020 and 2021.There are no robust works describing the profile of liver transplant patients who are victims of COVID-19, especially when it comes to comparing this profile against the waves. We carried out a national multicenter study that can cover a significant number of liver transplant patients and verify the prognostic factors of survival of these patients according to the period of illness by COVID-19. The main objective of this study was to evaluate factors associated with wave survival in COVID-19 disease, in the postoperative period of liver transplantation.This is a cross-sectional, retrospective study, with analysis of data from the medical records of patients with suspicion or positivity for COVID-19 provided by the coordinators of the Liver Transplantation Groups of Brazil (GTxF-COVID-19/Brazil), through a survey applied online. In this study, 25 centers were evaluated, totaling 311 patients in the postoperative period of liver transplantation, of which 128 (41.1%) were treated at home and 183 (58.9%) were hospitalized. Of the 183 hospitalized, 54 (hospital mortality of 29.5%) died. The need for mechanical ventilation was 65/183 (35.5%).The prevalence in this study was 311/16345 (1.9% or 1,900) and mortality was about 291.2 per 100,000 inhab. (17.36%). There were no records of deaths at home. Evaluating the number of cases according to the waves of COVID-19, we observed that in wave 1 there were 131 cases (47.3%) and in wave 2 there were 146 cases (52.7%).In the two waves, the most frequent symptoms (over 10 cases) were: fever, cough, dyspnea, fatigue, coryza, headache, diarrhea, myalgia and dyspnea. The most frequent comorbidities in both waves were diabetes, hypertension, obesity, smoking, kidney disease and heart disease. The length of stay in ICU days was longer in the first wave (5.72 ± 11.79; p=0.04) than in the second wave. There was a greater number of hospital admissions in the first wave, 70.2% against 53.4% in the second wave (p=0.004). There was a greater number of “pre” COVID-19 treatment (use of hydroxychloroquine, chloroquine and azithromycin) in the first wave (65.6%) compared to the second wave (51.9%) and this difference was significant (p= 0.03).There was less management, reduction or withdrawal of immunosuppression in these patients in the second wave (p=0.02). The actuarial survival curve estimated by the Kaplan-Meier method comparing survival from the onset of symptoms to resolution of the patients’ clinical condition did not show a statistically significant difference between the two waves.As already mentioned, there are no reports of cases similar to ours in relation to COVID-19 after liver transplantation, however, studies such as the one presented here are imperative in order to create solid foundations for definitions of the management of this population that requires attention and safe criteria.