Management of Immunosuppression Treatment in Autoimmune Liver Disease and Liver Transplantation Patients Infected with COVID-19

INTRODUCTION: It is known that viral infections progress more seriously in immunosuppressed patients than in the healthy population. In the literature, there is limited information on the course of COVID-19 infection in patients with autoimmune liver disease (AID) who receive immunosuppressive therapy, and in patients who have undergone liver transplantation. We present in detail the course of twelve patients, including six patients with AID and six patients with liver transplantation, who had COVID-19 infection and were followed up under immunosuppressive therapy.
METHODS: Six AID and six liver transplant patients with COVID-19 infection were examined in detail from 58 AID and 72 liver transplant patients followed in the hepatology outpatient clinic of our hospital. Demographic data such as age and gender, underlying liver diseases, medical treatments received, and how medical treatment was affected during COVID-19 infection were examined in detail.
RESULTS: The mean age of the twelve patients included in the study was 38.1±5.2 years, with 7 (58.3%) patients being male and 5 (46.7%) female. Two patients with cirrhosis-associated AID who are in remission under azathioprine monotherapy had their treatment dose reduced by half, while the others did not change. While the dose of immunosuppressant was reduced by half and methylprednisolone treatment was added in two of the transplant patients, no dose change was required in the other patient. All patients were discharged with full recovery.
DISCUSSION AND CONCLUSION: Interruption of immunosuppressive therapies is not appropriate because they prevent the activation of the underlying AID, prevent liver rejection in transplanted patients, as well as cytokine storm, which is the most important cause of mortality in COVID-19 disease. However, dose reduction can be made in selected cases.