Tacrolimus eases COVID-19 death risk in liver transplant recipients

Mortality from the novel coronavirus disease (COVID-19) is higher among liver transplant (LT) recipients, particularly those who are older and have comorbidities, a recent study has shown. Conversely, the use of tacrolimus appears protective against COVID-19 deaths.

The study included 243 adult LT recipients (median age, 63 years, 70.37 percent men) with symptomatic COVID-19. A total of 204 participants required hospitalization. Only 57 had no comorbidities, while 107 had ≥2 comorbidities. Hypertension (n=111) and diabetes (n=94) were the most common comorbidities detected. Overall, 162 (66.67 percent) were on tacrolimus.

A total of 49 patients died after a median of 13.5 days, yielding a mortality rate of 20.2 percent. Respiratory failure was the most common cause of death (n=39; 77.6 percent). The overall estimated probabilities of survival were 88.2 percent and 84.4 percent at 30 and 90 days, respectively.

Cox proportional hazards analysis showed that advanced age was a significant risk factor for COVID-19 mortality in LT recipients (>70 vs <60 years; hazard ratio [HR], 4.16, 95 percent confidence interval [CI], 1.78–9.73), while the use of tacrolimus emerged as significantly protective (HR, 0.55, 95 percent CI, 0.31–0.99).

Because comorbidities tended to accumulate with age, the researchers constructed a separate model that excluded patient age. This analysis revealed that diabetes and chronic renal failure were also predictors of mortality, and their effects were potentially overshadowed by the dominant effect of age in the initial model.

“[O]ur preliminary evidence should encourage clinicians to keep tacrolimus at the usual dose because it may be beneficial when treating COVID-19. A more precise estimate of the protective effect of tacrolimus requires studies on larger cohorts of transplant recipients,” the researchers said.