{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:54:42Z","timestamp":1760057682829,"version":"build-2065373602"},"reference-count":61,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,2,16]],"date-time":"2025-02-16T00:00:00Z","timestamp":1739664000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Liver transplant recipients (LTRs) have been considered a population group that is vulnerable to COVID-19 as they are chronically immunosuppressed patients with frequent comorbidities. This study describes the course of the SARS-CoV-2 disease from February 2020 to December 2023 along seven pandemic \u201cwaves\u201d. We carried out an observational study on 307 COVID-19 cases in a cohort of LTRs with the aim of evaluating the changes in the disease characteristics over time and determining the risk factors for severe COVID-19. An older age and serum creatinine level \u2265 2 mg\/dL were found to be risk factors for hospital admission and respiratory failure. The use of calcineurin inhibitors was a protective factor for death, hospitalization, and respiratory failure from COVID-19. One hundred percent of patients who died (N = 12) were on mycophenolate mofetil, which was a determinant for respiratory failure. Azathioprine was associated with admission to the intensive care unit (ICU) and with invasive mechanical ventilation (IMV). Vaccination was a protective factor for hospitalization, respiratory failure, and mortality. The severe COVID-19 rate was higher during the first five waves, with a peak of 57.14%, and the highest mortality rate (21.43%) occurred in the fourth wave. The IMV and ICU admission rates did not show significant differences across the periods studied.<\/jats:p>","DOI":"10.3390\/v17020273","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T07:48:22Z","timestamp":1739778502000},"page":"273","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Impact and Evolution of COVID-19 on Liver Transplant Recipients Throughout the Pandemic \u201cWaves\u201d in a Single Center"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9106-0110","authenticated-orcid":false,"given":"Clara Fern\u00e1ndez","family":"Fern\u00e1ndez","sequence":"first","affiliation":[{"name":"HBP and Transplant Surgery Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario \u201c12 de Octubre\u201d, 28041 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Blanca Otero","family":"Torr\u00f3n","sequence":"additional","affiliation":[{"name":"HBP and Transplant Surgery Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario \u201c12 de Octubre\u201d, 28041 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mercedes Bernaldo","family":"de Quir\u00f3s Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"HBP and Transplant Surgery Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario \u201c12 de Octubre\u201d, 28041 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafael San Juan","family":"Garrido","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, Hospital Universitario \u201c12 de Octubre\u201d, 28041 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2147-2811","authenticated-orcid":false,"given":"Cristina Mart\u00edn-Arriscado","family":"Arroba","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n, Hospital \u201c12 de Octubre\u201d (imas12), 28041 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0553-5835","authenticated-orcid":false,"given":"Iago Justo","family":"Alonso","sequence":"additional","affiliation":[{"name":"HBP and Transplant Surgery Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario \u201c12 de Octubre\u201d, 28041 Madrid, Spain"},{"name":"School of Medicine, Complutense University of Madrid, Avenida de Cordoba s\/n, 28041 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6266-8792","authenticated-orcid":false,"given":"Alberto Alejandro Marcacuzco","family":"Quinto","sequence":"additional","affiliation":[{"name":"HBP and Transplant Surgery Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario \u201c12 de Octubre\u201d, 28041 Madrid, Spain"},{"name":"School of Medicine, Complutense University of Madrid, Avenida de Cordoba s\/n, 28041 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8953-269X","authenticated-orcid":false,"given":"\u00d3scar Caso","family":"Maestro","sequence":"additional","affiliation":[{"name":"HBP and Transplant Surgery Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario \u201c12 de Octubre\u201d, 28041 Madrid, Spain"},{"name":"School of Medicine, Complutense University of Madrid, Avenida de Cordoba s\/n, 28041 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5799-0170","authenticated-orcid":false,"given":"F\u00e9lix Cambra","family":"Molero","sequence":"additional","affiliation":[{"name":"HBP and Transplant Surgery Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario \u201c12 de Octubre\u201d, 28041 Madrid, Spain"},{"name":"School of Medicine, Complutense University of Madrid, Avenida de Cordoba s\/n, 28041 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oana Anisa","family":"Nutu","sequence":"additional","affiliation":[{"name":"HBP and Transplant Surgery Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario \u201c12 de Octubre\u201d, 28041 Madrid, Spain"},{"name":"School of Medicine, Complutense University of Madrid, Avenida de Cordoba s\/n, 28041 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Calvo Pulido","sequence":"additional","affiliation":[{"name":"HBP and Transplant Surgery Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario \u201c12 de Octubre\u201d, 28041 Madrid, Spain"},{"name":"School of Medicine, Complutense University of Madrid, Avenida de Cordoba s\/n, 28041 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alejandro","family":"Manrique Municio","sequence":"additional","affiliation":[{"name":"HBP and Transplant Surgery Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario \u201c12 de Octubre\u201d, 28041 Madrid, Spain"},{"name":"School of Medicine, Complutense University of Madrid, Avenida de Cordoba s\/n, 28041 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c1lvaro","family":"Garc\u00eda-Sesma P\u00e9rez-Fuentes","sequence":"additional","affiliation":[{"name":"HBP and Transplant Surgery Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario \u201c12 de Octubre\u201d, 28041 Madrid, Spain"},{"name":"School of Medicine, Complutense University of Madrid, Avenida de Cordoba s\/n, 28041 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1873-0568","authenticated-orcid":false,"given":"Carmelo","family":"Loinaz Segurola","sequence":"additional","affiliation":[{"name":"HBP and Transplant Surgery Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario \u201c12 de Octubre\u201d, 28041 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n, Hospital \u201c12 de Octubre\u201d (imas12), 28041 Madrid, Spain"},{"name":"School of Medicine, Complutense University of Madrid, Avenida de Cordoba s\/n, 28041 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,16]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2024, November 01). 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