A case of COVID-19 immediately after liver transplantation: Not only bad news (original) (raw)
Related papers
Successful Management of COVID-19 Infection in 2 Early Post-Liver Transplant Recipients
Transplantation Proceedings, 2021
Background. Coronavirus disease 2019 (COVID-19) has affected all facets of life and continues to cripple nations. COVID-19 has taken the lives of more than 2.1 million people worldwide, with a global mortality rate of 2.2%. Current COVID-19 treatment options include supportive respiratory care, parenteral corticosteroids, and remdesivir. Although COVID-19 is associated with increased risk of morbidity and mortality in patients with comorbidities, the vulnerability, clinical course, optimal management, and prognosis of COVID-19 infection in patients with organ transplants has not been well described in the literature. The treatment of COVID-19 differs based on the organ(s) transplanted. Preliminary data suggested that liver transplant patients with COVID-19 did not have higher mortality rates than untransplanted COVID-19 patients. Table 1 depicts a compiled list of current published data on COVID-19 liver transplant patients. Most of these studies included both recent and old liver transplant patients. No distinction was made for early liver transplant patients who contract COVID-19 within their posttransplant hospitalization course. This potential differentiation needs to be further explored. Here, we report 2 patients who underwent liver transplantation who acquired COVID-19 during their posttransplant recovery period in the hospital. Case Descriptions. Two patients who underwent liver transplant and contracted COVID-19 in the early posttransplant period and were treated with hydroxychloroquine, methylprednisolone, tocilizumab, and convalescent plasma. This article includes a description of their hospital course, including treatment and recovery. Conclusion. The management of post-liver transplant patients with COVID-19 infection is complicated. Strict exposure precaution practice after organ transplantation is highly recommended. Widespread vaccination will help with prevention, but there will continue to be patients who contract COVID-19. Therefore, continued research into appropriate treatments is still relevant and critical. A temporary dose reduction of immunosuppression and continued administration of low-dose methylprednisolone, remdesivir, monoclonal antibodies, and convalescent plasma might be helpful in the management and recovery of severe COVID-19 pneumonia in post-liver transplant patients. Future studies and experiences from posttransplant patients are warranted to better delineate the clinical features and optimal management of COVID-19 infection in liver transplant recipients. C ORONAVIRUS disease 2019 (COVID-19) has affected all facets of life and continues to cripple nations. COVID-19
COVID-19 in Liver Transplant Recipients - A Series with Successful Recovery
Journal of Clinical and Translational Hepatology
The severe acute respiratory syndrome corona virus-2 (referred to as SARS-CoV-2) pandemic had a great impact on public life in general as well as on populations with preexisting disease and co-morbidities. Liver transplant and immunosuppressant medication predisposes to more severe disease and is often associated with poor outcome. The clinical features, disease course, treatment and process of modulating the immunosuppression is challenging. Here, we describe the clinical presentation, treatment and outcomes in six liver transplant recipients. Out of those six patients, three had mild, one had moderate and one had severe COVID-19, and one was asymptomatic. The immunosuppression minimization or withdrawal was done based upon the clinical severity. Consideration of tocilizumab and/or convalescent plasma as well as antivirals i.e. remdesvir done in severe cases. The routine practice of prophylactic anticoagulation, consideration of repurposed drugs (i.e. teicoplanin and doxycycline), and watchful monitoring of asymptomatic recipients helped to achieve an uneventful recovery.
Successful treatment of severe COVID‐19 pneumonia in a liver transplant recipient
American Journal of Transplantation, 2020
, an outbreak of pneumonia caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in Wuhan, Hubei province, and spread to other regions in China. 1,2 As of March 15 2020, more than 81 000 confirmed cases infected with COVID-19 have been identified in China, of them 3204 patients died. Given that the current COVID-19 outbreak is moving rapidly, there have been 72 469 accumulated confirmed cases reported in over 140 countries/areas around the world (http://www.who.int). 3 COVID-19 pandemic may be an increasing challenge for transplant community. Temporary closure of donation and cessation of transplantation would be in consideration in the epidemic area. 4 Transplant patients are susceptible population to SARS-CoV-2, with majorities usually require lifelong immunosuppressive therapy. Immunosuppression that reduce cell-mediated immunity may prolong shedding of coronavirus and increase the risk of infectious complications. 5 However, it is recently reported that immunosuppressed patients are not at increased risk of severe pulmonary disease compared to the general population and there are no reasons to postpone transplantation during COVID-19 outbreaks. 6 Indeed, there is not yet enough data to describe the epidemic situation of COVID-19 in transplant population since it is ongoing. Though the information about COVID-19 is evolving rapidly, whether COVID-19 has donor-to-recipient transmission and its short term or long-term impact on infected immunocompromised patients is still unclear. So far, literature reports on COVID-19 infection in solid organ transplantation are limited. Herein, we report a liver transplant recipient who has recovered from severe COVID-19 pneumonia. 2 | MATERIAL S AND ME THODS We retrospectively collected and analyzed data on a liver transplant recipient with laboratory-confirmed COVID-19 infection. Data were obtained from electronic medical records. We also directly communicated with the recipient and his family to ascertain epidemiological
Hepatology International, 2020
Annually, around 850 liver transplantation is performed in Beijing, China. Recently, the new coronavirus pneumonia (COVID-19) caused by 2019 novel coronavirus (2019-nCoV) has affected nearly 200 countries worldwide. 2019-nCov can cause severe lung disease, multiple-organ damage, and significant mortalities. Liver transplant recipients, because of long-term oral immunosuppressant effects, may be more susceptible to 2019-nCoV infection and have a worse prognosis than the general population. It is urgent to set up guidelines for the prevention, diagnosis, and treatment of COVID-19 in liver transplant recipients. In this article, we reviewed the clinical aspects of 2019-nCoV infection, characteristics of liver transplant recipients, immunosuppressant usage, and potential drug interactions to provide recommendations to clinical staff managing liver transplant recipients during the COVID-19 epidemic.
Transplant Infectious Disease, 2020
The impact of coronavirus disease‐19 (COVID‐19) in liver recipients remains largely unknown. Most data derive from small retrospective series of patients transplanted years ago. We aimed to report a single‐center case series of five consecutive patients in the early postoperative period of deceased‐donor liver transplantation who developed nosocomial COVID‐19. Two patients presented important respiratory discomfort and eventually died. One was 69 years old and had severe coronary disease. She rapidly worsened after COVID‐19 diagnosis on 9th postoperative day. The other was 67 years old with non‐alcoholic steatohepatitis, who experienced prolonged postoperative course, complicated with cytomegalovirus infection and kidney failure. He was diagnosed on 36th postoperative day and remained on mechanical ventilation for 20 days, ultimately succumbing of secondary bacterial infection. The third, fourth, and fifth patients were diagnosed on 10th, 11th, and 18th postoperative day, respective...
Ethiopian Journal of Health Sciences, 2021
Background This systematic review is conducted to explore available information on clinical presentations, laboratory finding and outcomes of SARS-COV-2 in liver transplant patients. Methods We searched four databases for relevant terms related to COVID-19 and liver transplantation and collected both case reports and case series on liver transplantation published up to the end of September 2020. Results After initial screening of irrelevant articles, 25 studies were included and analyzed in this review. Among the 59 patients included, 78.3% were over 50 years old, and 71.6% were males. The majority of patients (93.3%) were hospitalized. The most common presenting symptoms were fever (72.9%) followed by dyspnea and cough (54.2%). The majority of patients revealed a high level of CRP (64.3%). Moreover, high level ALT, AST and ALP were reported in 64.3, 37.5, 30.5 and 22.2% of patients. A total, 9(15.3%), of cases died as a result of complications of COVID-19. Chest radiographs were re...
Transplant Infectious Disease, 2020
Background Which are the consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection in liver transplant (LT) recipients? Methods We attempted to address this question by reviewing our single-center experience during the first two months of the pandemics at a high incidence area. Results Nineteen adult patients (5 females) were diagnosed by May 5th, 2020. Median age was 58 (range 55-72), and median follow-up since transplantation was 83 (range 20-183) months. Cough (84.2%), fever (57.9%) and dyspnea (47.4%) were the most common symptoms. Thirteen patients (68.4%) had pneumonia in X-ray/CT scan. Hydroxychloroquine was administered in 11 patients, associated with lopinavir/ritonavir and interferon β in 2 cases each. Immunomodulatory therapy with tocilizumab was used in 2 patients. Immunosuppression (IS) was halted in one patient, and modified in only other two due to potential drug interactions. Five (26.3%) patients were managed as outpatient. Two patients (10.5%) died, 10 (52.6%) were discharged home, and 2 (10.5%) were still hospitalized after a median follow-up of 41 days from the onset of symptoms. Baseline IS regimen remained unchanged in all surviving recipients, with good liver function. Conclusions Our preliminary experience shows a broad spectrum of disease severity in LT patients with COVID-19, with a favorable outcome in most of them without needing to modify baseline IS.
Crucial Aspects of Management of Solid Organ Transplant Patient with COVID-19: a Narrative Review
Many centres worldwide raised the concern that immunocompromised patients for solid organ transplantation may be at high risk of developing a severe respiratory disease by SARS-CoV-2 infection. Currently, there are no specific data on COVID-19 in patients with generalized immunosuppression and transplantation. In this narrative review, we reported the main data of COVID-19 in patients with solid organ transplantation presented in the literature. The aim is to elaborate a strategy for tailored management, from diagnosis to therapy. The management of adult patients with solid organ transplantation and COVID-19 is a challenge for the clinicians. There is a lack of data in the literature, but three key-points are crucial: in the "pandemic era," consider the symptomatic patient as positive for SARS-CoV-2 until proven otherwise; adjust/stop immunosuppressive agents; protect graft function with adequate route and dose administration of glucocorticoid and supportive measures. For pediatric patients, data are scarce. It is unclear if immunosuppression in patients with solid organ transplantation alters the predisposition to acquiring COVID-19 or if the disease implications are modified for better or for worse. Further studies are needed.
American Journal of Transplantation, 2021
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is rapidly spreading among humans, causing a mild-to-severe, cold-like, respiratory tract infection, 1,2 known as coronavirus disease 2019 (COVID-19). 3 As of February 15, 2021, more than 108 millions of people have been infected, and more than 2.0 (2.2%) million deaths were globally detected since the start of the pandemic. 4 The clinical spectrum of COVID-19 widely differs among infected individuals, including from asymptomatic to patients with severe and quickly progressing lethal pneumonia. 5
American Journal of Transplantation, 2020
The coronavirus disease 2019 (COVID-19) pandemic caused by SARS coronavirus 2 (SARS-CoV-2) has caused significant morbidity and mortality for patients and stressed healthcare systems worldwide. The clinical features, disease course, and serologic response of COVID-19 among immunosuppressed patients such as solid organ transplant (SOT) recipients, who are at presumed risk for more severe disease, are not well characterized. We describe our institutional experience with COVID-19 among 10 SOT patients, including the clinical presentation, treatment modalities, and outcomes of 7 renal transplant recipients, 1 liver transplant recipient, 1 heart transplant recipient, and 1 lung transplant recipient. In addition, we report the serologic response in SOT recipients, documenting a positive IgG response in all 7 hospitalized patients. We also review the existing literature on COVID-19 in SOT recipients to The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a global pandemic with > 11 million reported cases and > 500 000 deaths. 1,2 Clinical coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 varies from asymptomatic infection to critical illness with acute respiratory distress syndrome. 3,4 Clinical manifestations include fever, fatigue, myalgias, dry cough, dyspnea, anosmia, and dysgeusia. 5,6 Along with comorbidities such as hypertension, diabetes, cardiovascular disease, and chronic lung or kidney disease, malignancy is an identified risk factor for severe COVID-19 disease. 4,7,8 However, the clinical presentation and disease course among other immunocompromised patients, including solid organ transplant (SOT) recipients, are not well characterized. Although SOT recipients with other respiratory virus infections often exhibit severe lower respiratory tract infection, 9 the association between COVID-19 and intense cytokine release 10 raises the possibility that immunosuppression may actually temper the exuberant inflammatory response in severe disease. Furthermore, despite interest in using SARS-CoV-2 serology to improve diagnosis and predict immunity, it is unknown whether SOT recipients will mount an antibody response against SARS-CoV-2. This study aims to build our understanding of COVID-19 disease in the SOT population. We present the clinical features of COVID-19 in 10 SOT recipients at our institution and describe the SARS-CoV2 serologic response in the 7 hospitalized SOT recipients. 2 | MATERIAL S AND ME THODS 2.1 | Study subjects and setting Adult SOT recipients (age ≥18 years) cared for at the University of California San Francisco (UCSF) and diagnosed with COVID-19 by RNA testing were identified via comprehensive standard clinical