Understanding Clinical Outcomes Associated With Mycophenolate Use Among Liver and Renal Transplant Recipients Infected With SARS-CoV2

Document Type

Conference Proceeding

Publication Date

10-25-2023

Publication Title

Am J Gastroenterol

Abstract

Introduction: The use of long-term immunosuppressants in solid organ transplant recipients has been shown to increase COVID-19 related morbidity and mortality. However, further studies examining outcomes for specific types of immunosuppressants is limited. We aim to evaluate how mycophenolate use affects outcomes for liver and renal transplant (LRT) recipients infected with SARS-CoV-2. Methods: A retrospective study of LRT recipients diagnosed with COVID-19 between 3/2020 to 1/2022 was performed. We recorded data on patient demographics, immunosuppressants, vaccine dose numbers, MAB treatment, hospitalization, length of stay (LOS, days), mechanical ventilation (MV) use, as well as 3- and 6-month mortality. Statistical analysis included Chi Square tests, t-tests and logistic regression. Results: Out of 255 LRT recipients diagnosed with COVID-19, 68 (26%) were liver transplant patients, 177 (69%) were renal transplant patients, and 10 (4%) had received dual LRT. Comparing liver and renal transplant patients, there were no significant differences in hospitalization and mortality rates. This analysis was further stratified to examine the effects of Mycophenolate. Among 199 patients using mycophenolate, there was a higher incidence of hospitalization (62% vs 55% P =0.383), mechanical ventilation (24% vs 10% P=0.135), and mortality at 3 and 6 months compared to non-users (18% vs 9% P=0.099 and 20% vs 11% P=0.123). In the liver transplant subgroup (78 patients, 68% on mycophenolate), mycophenolate use was associated with increased hospitalization rates (58% vs 44% P=0.231) and higher mortality at 3 and 6 months compared to non-users (19% vs 0% P=0.020 and 11% vs 0% P=0.014, respectively). In the renal transplant subgroup (187 patients, 81% on mycophenolate), there was no difference in hospitalization rates between users and non-users (62% vs 62%). When comparing 47 liver to 146 renal transplant patients on mycophenolate (excluding dual LRT patients), there were no significant differences in hospitalization (P=0.672), mortality at 3 months (P=0.595), or mortality at 6 months (P=0.530). Conclusion: Our data demonstrates that mycophenolate was associated with increased hospitalization and mortality rates, with similar trends observed specifically in liver transplant patients. Furthermore, there was no difference in outcomes with the use of mycophenolate when comparing liver and renal transplant patients, indicating consistent trends of mycophenolate impacting morbidity.

Volume

118

Issue

10

First Page

S1205

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