Effect of COVID-19 Pandemic on Patients Who Have Undergone Liver Transplantation Because of Hepatocellular Carcinoma.

BACKGROUND AND AIM: Many clinical studies have shown that the COVID-19 case fatality rate is higher in older patients, those with comorbidities, those with immunosuppressive conditions, and those who stay in the intensive care unit. This study aims to evaluate the clinical outcomes of 66 liver transplant (LT) patients with primary liver cancer who were exposed to COVID-19 infection. METHODS: Demographic and clinical data of 66 patients with primary liver cancer (hepatocellular carcinoma = 64, hepatoblastoma = 1, cholangiocarcinoma = 1) who underwent LT in our institute and were exposed to COVID-19 infection between March 2020 and November 2021 were analyzed in this cross-sectional study. The following data of the patients were recorded: age, sex, body mass index (kg/m2), blood group, underlying primary liver disease, smoking, tumor characteristics, post-transplant immunosuppressive agents, COVID-19 symptoms, hospitalization, intensive care unit stay, intubation, and other clinical features. RESULTS: There were 55 (83.3%) male and 11 (16.7%) female patients, with a median age of 58 years. Sixty-four patients were exposed to COVID-19 only once, whereas the remaining 2 patients were exposed 2 and 4 times, respectively. After exposure to COVID-19, it was determined that 37 patients used antiviral drugs, 25 were hospitalized, 9 were followed in the intensive care unit, and 3 were intubated. One intubated patient was under hospital follow-up because of biliary complications before exposure to COVID-19, and this patient died from sepsis. CONCLUSION: The low mortality rate of LT patients with primary liver cancer exposed to COVID-19 infection can be attributed to background immunosuppression that prevents cytokine storm. However, it is appropriate to support this study with multicenter studies to make strong comments on this issue.

Effect of the COVID-19 Pandemic on the Psychological Health of Patients Who Underwent Liver Transplantation Due to Hepatocellular Carcinoma.

BACKGROUND: The primary aim of this study was to compare liver transplant (LT) recipients with and without hepatocellular carcinoma (HCC) in terms of COVID-19-related depression, anxiety, and stress. METHOD: A total of 504 LT recipients with (HCC group; n = 252) and without HCC (non-HCC group; n = 252) were included in the present case-control study. Depression Anxiety Stress Scales (DASS-21) and Coronavirus Anxiety Scale (CAS) were used to evaluate the depression, stress, and anxiety levels of LT patients. DASS-21 total and CAS-SF scores were determined as the primary outcomes of the study. Poisson regression and negative binomial regression models were used to predict the DASS and CAS scores. The incidence rate ratio (IRR) was used as a coefficient. Both groups were also compared in terms of awareness of the COVID-19 vaccine. RESULTS: Poisson regression and negative binomial regression analyses for DASS-21 total and CAS-SF scales showed that the negative binomial regression method was the appropriate model for both scales. According to this model, it was determined that the following independent variables increased the DASS-21 total score: non-HCC (IRR: 1.26; p = 0.031), female gender (IRR: 1.29; p = 0.036), presence of chronic disease (IRR: 1.65; p < 0.001), exposure to COVID-19 (IRR: 1.63; p < 0.001), and nonvaccination (IRR: 1.50; p = 0.002). On the other hand, it was determined that the following independent variables increased the CAS score: female gender (IRR:1.75; p = 0.014) and exposure to COVID-19 (IRR: 1.51; p = 0.048). Significant differences were found between the HCC and non-HCC groups in terms of median DASS-21 total (p < 0.001) and CAS-SF (p = 0.002) scores. Cronbach's alpha internal consistency coefficients of DASS-21 total and CAS-SF scales were calculated to be 0.823 and 0.783, respectively. CONCLUSION: This study showed that the variables including patients without HCC, female gender, having a chronic disease, being exposed to COVID-19, and not being vaccinated against COVID-19 increased anxiety, depression, and stress. High internal consistency coefficients obtained from both scales indicate that these results are reliable.

Effect of COVID-19 Pandemic on Patients Who Have Undergone Liver Transplantation Due to Hepatocellular Carcinoma

Background and Aim Many clinical studies have shown that the COVID-19 case fatality rate is higher in elderly patients, those with comorbidities, those with immunosuppressive conditions, and those who stay in the intensive care unit. The aim of this study is to evaluate the clinical outcomes of 66 liver transplant (LT) patients with primary liver cancer who were exposed to COVID-19 infection. Methods Demographic and clinical data of a total of 66 patients with primary liver cancer (hepatocellular carcinoma= 64, hepatoblastoma=1, cholangiocarcinoma=1) who underwent LT in our institute and were exposed to COVID-19 infection between March 2020 and November 2021 were analyzed in this cross-sectional study. The following data of the patients were recorded: age, gender, BMI (kg/m2), blood group, underlying primary liver disease, smoking, tumor characteristics, post-transplant immunosuppressive agents, COVID-19 symptoms, hospitalization, intensive care unit (ICU) stay, intubation, and other clinical features. Results There were 55 (83.3%) male and 11 (16.7%) female, with a median age of 58 years. Sixty-four patients were exposed to COVID-19 only once, while the remaining two were exposed two and four times, respectively. After exposure to COVID-19, it was determined that 37 patients used antiviral drugs, 25 patients were hospitalized, 9 patients were followed in the intensive care unit, and three patients were intubated. One intubated patient was under hospital follow-up due to biliary complications before exposure to COVID-19, and this patient died due to sepsis. Conclusion The good of LT patients with primary liver cancer who were exposed to COVID-19 infection can be attributed to background immunosuppression which prevents cytokine storm. However, it is appropriate to support this study with multicenter studies to make strong comments on this issue.

Fear of COVID 19 and social effects in liver transplant patients.

BACKGROUND: This study was descriptively conducted to evaluate the fear of COVID 19 and its social effects on patients who had liver transplant. METHODS: The study was conducted between September 2020 and April 2021 in a liver transplant institute affiliated with a university hospital. The sample of the study was 135 patients. Personal Information Form, Fear of Covid 19 Scale, and Questionnaire of Social Impact of COVID 19 Pandemic were used to collect data. RESULTS: It was determined that the Fear of Covid 19 Scale mean score of the patients was 21.25 ± 6.99. As the fear of COVID 19 increases in patients who had liver transplant, it was determined that their desire to be in crowded environments, to prefer public transportation, to go to the doctor for examination and their focusing on various objectives were decreasing. Also, fear of COVID 19 increased the difficulty in sleep, storage of food and cleaning materials, washing hands frequently, using masks and gloves when going out, health concerns, doubts about disease symptoms, orientation towards healthy eating, worries about the future and questioning the meaning of life. CONCLUSION: The results show that it is important for transplant centers to be able to provide guidance and psychological counseling services to liver transplant patients, who are significantly affected by COVID 19, through telemedicine or various technological opportunities.