Successful orthotopic liver transplantation in a patient with a positive SARS-CoV2 test and acute liver failure secondary to acetaminophen overdose

Abstract

SARS-CoV2, first described in December 2019, was declared a pandemic by the World Health Organization in March 2020. Various surgical and medical societies promptly published guidelines, based on expert opinion, on managing patients with COVID-19, with a consensus to postpone elective surgeries and procedures. We describe the case of an orthotopic liver transplantation (OLT) in a young female who presented with acute liver failure secondary to acetaminophen toxicity to manage abdominal pain and in the setting of a positive SARS-CoV2 test. Despite a positive test, she had no respiratory symptoms at time of presentation. The positive test was thought to be residual viral load. The patient had a very favorable outcome, likely related to multiple factors including her young age, lack of respiratory COVID-19 manifestations and plasma exchange peri-operatively. We recommend a full work-up for OLT in COVID-19 patients with uncomplicated disease according to standard of care, with careful interpretation of COVID-19 testing in patients presenting with conditions requiring urgent or emergent surgery as well as repeat testing even a few days after initial testing, as this could alter management.

Keywords: clinical research/practice; drug toxicity; fulminant hepatic failure; infection and infectious agents - viral; infectious disease; liver transplantation/hepatology; plasmapheresis/plasma exchange.

FIGURE 1

(A) Chest X-ray upon admission; (B) computerized tomography of the abdomen and pelvis upon admission with evidence of colitis; (C) computerized tomography of the brain with evidence of brain edema; (D) computerized tomography of the chest with no gross interstitial lung disease and evidence of mild pneumomediastinum