Early liver transplantation after COVID-19 infection: The first report

Abstract

COVID-19 (coronavirus disease 2019) has impacted solid organ transplantation (SOT) in many ways. Transplant centers have initiated SOT despite the COVID-19 pandemic. Although it is suggested to wait for 4 weeks after COVID-19 infection, there are no data to support or refute the timing of liver transplant after COVID-19 infection. Here we describe the course and outcomes of COVID-19-infected candidates and healthy living liver donors who underwent transplantation. A total of 38 candidates and 33 potential living donors were evaluated from May 20, 2020 until October 30, 2020. Ten candidates and five donors were reverse transcriptase-polymerase chain reaction (RT-PCR) positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pretransplant. Four candidates succumbed preoperatively. Given the worsening of liver disease, four candidates underwent liver transplant after 2 weeks due to the worsening of liver disease and the other two candidates after 4 weeks. Only one recipient died due to sepsis posttransplant. Three donors underwent successful liver donation surgery after 4 weeks of COVID-19 infection without any postoperative complications, and the other two were delisted (as the candidates expired). This report is the first to demonstrate the feasibility of elective liver transplant early after COVID-19 infection.

Keywords: clinical research/practice; infection and infectious agents; liver transplantation/hepatology; liver transplantation: living donor.

FIGURE 1

Protocol for liver transplant after a SARS-CoV-2 infection. CT, computed tomography; LT, liver transplantation; RT-PCR, reverse transcriptase-polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus-2 [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Flowchart depicting the candidates and donors screened/transplanted during the study period

FIGURE 3

Timeline of COVID-19 in candidates who succumbed pretransplant. Candidates 7 and 8 succumbed to liver disease, and candidates 9 and 10 succumbed to COVID-19. ACLF, acute on chronic liver failure;ALF, acute liver failure; COVID-19, coronavirus disease2019; CRRT, continuous renal replacement therapy; HAV, hepatitis A virus; MELD, Model for End-Stage Liver Disease; RT-PCR, reverse transcriptase-polymerase chain reaction [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 4

Change in serum total bilirubin after liver transplant in recipients (#1–6) from postoperative day 1 to day 30