Clinical Practice Issues for Liver Transplantation in COVID-19 Recovered Recipients (original) (raw)

Effects of COVID-19 on Living Donor Liver Transplantation

Acta Scientific Gastrointestinal Disorders, 2021

Background and Aims: The novel Coronavirus (COVID-19) pandemic with rapidly rising number of cases and high mortality massively affected living donor liver transplantation in Pakistan. The study aims at providing an insight into the transplantation in era of pandemic, its effects on LDLT in postoperative period. Methods: All the patients listed for LDLT at PAQSJIMS from March 1st to June 30th 2020 were re-evaluated for LDLT, after an initial complete halt and mortality of 3, in terms of CTP, MELD, COVID PCR and CT chest, for resumption of transplantation services and were closely monitored postoperatively. Results: 54 patients with Child C, MELD above 15 and negative PCR/HRCT underwent LDLT. 6 (5 recipients and 1 donor) out of 70 listed , tested positive on PCR, were deferred from surgery and followed. Majority of recipients were males in their forties to sixties, with normal BMI, no comorbidities, and underwent LDLT for chronic viral hepatitis with decompensated cirrhosis (HBV+ HDV, HBV, HCV) and unresectable hepatocellular carcinoma. Postoperatively 5 Recipients (no donors) were diagnosed with SARS clinically, 4 tested positive on PCR and 1 had CT findings highly suggestive of COVID infection. Mortality was 2/5, caused by MOF in patient with prolonged illness, and sudden cardiac death in a relatively well patient. Conclusion: In conclusion, COVID 19 can have an atypical clinical presentation in postliver transplant patients, patients may be presymptomatic or asymptomatic and can have cardiac arrhythmias. Symptomatic patients may not necessarily have Positive PCRs, HRCT findings should be considered in all symptomatic patients, before labelling them COVID negative based on PCR. Strictly following SOPs can reduce transmission of COVID-19.

Covid-19 in recipients of living donor liver transplantation: a worse or an equivalent outcome?

QJM: An International Journal of Medicine, 2021

Summary Background Coronavirus disease 2019 (Covid-19) pandemic is representing a massive burden to the community with the new virus. There is few data regarding Covid-19 in liver transplant patients. Concerns were raised regarding the course of the disease in transplanted patients due to immunosuppression and risk of hepatic injuries. Aim To describe the outcomes of Covid-19 infection in recipients of living-donor liver transplantation (LDLT). Methods Retrospective analysis of 41 recipients of LDLT diagnosed with Covid-19 by real-time PCR or CT chest criteria of Covid-19 between April 2020 and April 2021. This Cohort was derived from Ain Shams Center for Organ Transplantation database, Ain Shams Specialized Hospital, Cairo, Egypt, which is considered one of the largest centers of LDLT in the Middle East. Patients were classified to mild, moderate, severe and critics according to clinical classification released by the National Health Commission of China. Results A total of 41 patie...

Epidemiological Pattern, Incidence and Outcomes of COVID-19 in Liver Transplant Patients

SSRN Electronic Journal, 2020

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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.

Living Donor Liver Transplantation During the COVID-19 Pandemic: an Evolving Challenge

Journal of Gastrointestinal Surgery

Background Maintaining standards of living donor liver transplantation (LDLT) can be a challenge during the corona virus disease 2019 (COVID-19) pandemic. Center-specific protocols have been developed and transplant societies propose limiting elective LDLT. We have looked at outcomes of LDLT during the pandemic in an exclusively LDLT center. Methods Patients were grouped into pre-COVID (January 2019-February 2020) (n = 162) and COVID (March 2020-January 2021) (n = 53) cohorts. We looked at patient characteristics, 30-day morbidity, and mortality. Outcomes were also assessed in donors and recipients who underwent surgery after recovery from COVID-19. Results The average number of transplants reduced from 11.5/month to 4.8/month. Fewer patients with MELD > 20 underwent LDLT in the COVID cohort (41.3% versus 24.5%, P = 0.03). Out of nine patients with a positive pretransplant COVID-19 PCR, there were 2 (22.3%) deaths on the waiting list. Seven patients underwent LT after recovery from COVID-19 with one 30-day mortality due to biliary sepsis. Three donors with positive COVID-19 PCR underwent uneventful donation after testing negative for COVID-19. No significant difference in 30-day survival was observed in the pre-COVID and COVID cohorts (93.2% versus 90.6%) (P = 0.3). Out of two recipients who developed COVID-19 pneumonia within 30 days after LT, there was one mortality. The 1-year survival for the entire cohort with a MELD cutoff of 20 was 90% and 84% (P = 0.2). Conclusion Despite comparable outcomes, fewer sick patients might undergo LDLT during the pandemic. Individuals recovered from COVID-19 might be safely considered for donation or transplantation.

Impact of COVID-19 on liver transplant recipients–A systematic review and meta-analysis

EClinicalMedicine, 2021

Background: Immunosuppression and comorbidities increase the risk of severe coronavirus disease-2019 (COVID-19) in solid organ transplant (SOT) recipients. The outcomes of COVID-19 in liver transplant (LT) recipients remain unclear. We aimed to analyse the outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in LT recipients. Methods: The electronic databases were searched for articles published from 1 December 2019 to 20 May 2021 with MeSH terms COVID-19, SARS-CoV-2, and liver transplantation. Studies reporting outcomes in more than 10 LT recipients were included for analysis. LT vs non-LT patients with COVID-19 infection were compared for all-cause mortality, which was the primary outcome studied. We also evaluated the relation between the timing of COVID-19 infection post-LT (< one year vs > one year) and mortality. Findings: Eighteen articles reporting 1,522 COVID-19 infected LT recipients were included for the systematic review. The mean age (standard deviation [SD]) was 60¢38 (5¢24) years, and 68¢5% were men. The mean time (SD) to COVID-19 infection was 5¢72 (1¢75) years. Based on 17 studies (I 2 = 7¢34) among 1,481 LT recipients, the cumulative incidence of mortality was 17¢4% (95% confidence interval [CI], 15¢4À19¢6). Mortality was comparable between LT (n = 610) and non-LT (n = 239,704) patients, based on four studies (odds ratio [OR], 0¢8 [0¢6À1¢08]; P = 0¢14). Additionally, there was no significant difference in mortality between those infected within one year vs after one year of LT (OR, 1¢5 [0¢63À3¢56]; P = 0¢35). The cumulative incidence of graft dysfunction was 2¢3% (1¢3À4¢1). Nearly 23% (20¢71À25) of the LT patients developed severe COVID-19 infection. Before infection, 71% and 49% of patients were on tacrolimus and mycophenolate mofetil, respectively. Immunosuppression was modified in 55¢9% (38¢1À72¢2) patients after COVID-19 infection. Interpretation: LT and non-LT patients with COVID-19 have a similar risk of adverse outcomes.

A case of COVID-19 immediately after liver transplantation: Not only bad news

Annals of Hepato-Biliary-Pancreatic Surgery, 2020

COVID-19, the illness caused by the SARS-CoV-2 virus originated in December 2019 in Wuhan, China and has caused more 3,3 million cases and more than 230,000 deaths throughout the world, with 25,000 of them only in Spain, where the first case was diagnosed on January 31st, 2020. As COVID-19 is a "new" disease, we still do not have data on prognosis or treatment in transplant patients or on how to manage immunosuppression in this complex scenario. We present a case of COVID-19 diagnosed during the early postoperative period in a recipient whose liver transplantation was performed on late March during the lockdown in Spain, with donor and recipient previously negative rRT-PCR to SARS-CoV-2. In the first post-operative week the patient suffered COVID-19 pneumonia that was treated with immunosuppression minimization, oral Hydroxycloroquine and Azithromycin with favorable outcome. The patient was discharged on POD 21 without complications. To date, few early post-liver transplantation SARS-CoV-2 infected recipients have been published, but only one was an early postoperative infection. In our case the outcome was favorable, even though it was an early post-liver transplantation COVID-19 in a frail patient.