Liver transplant recipients infected with SARS-CoV-2 in the early postoperative period: Lessons from a single center in the epicenter of the pandemic

Abstract

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, respectively, and presented satisfactory clinical evolution. These last two patients were severely immunosuppressed, since one underwent steroid bolus for acute cellular rejection and another also used anti-thymocyte globulin for treating steroid-resistant rejection. Our novel experience highlights that COVID-19 may negatively impact the postoperative course, especially in elder and obese patients with comorbidities, and draws attention to COVID-19 nosocomial spread in the early postoperative period.

Keywords: COVID-19; liver transplantation; postoperative period; severe acute respiratory syndrome coronavirus 2.

Figure 1

A and B, Thoracic computed tomography (CT) scan of patient 2, showing bilateral several ground‐glass pulmonary opacities affecting approximately 50% of the lungs, occasionally associated with thickening of interlobular septa and thin reticulate, in addition to peripheral sparse consolidation foci with greater extension in the posterior aspect of the lower lobes (A—axial view, B—coronal view). C, Thoracic CT scan of patient 3 on 10th postoperative day (POD), showing bilateral multiple ground‐glass pulmonary opacities, sometimes associated with thickening of interlobular septa and fine reticulate, affecting less than 50% of the lungs. D, Thoracic CT scan of the same patient on 20th POD, performed due to shortness of breath worsening, revealing increase in number and dimensions of ground‐glass pulmonary opacities, now affecting more than 50% of the lungs. E and F, Thoracic CT scan of patient 5, showing numerous bilateral peribronchovascular ground‐glass opacities, mainly in the upper lobes, some with thickening of the inter and intralobular septa. There is also a large pleural effusion on the right side with restrictive atelectasis of the adjacent pulmonary parenchyma (E—axial view, F—coronal view)