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. 2023 Oct;25(5):e14126.
doi: 10.1111/tid.14126. Epub 2023 Aug 16.

Favorable experience of transplant strategy including liver grafts from COVID-19 donors: One-year follow-up results

Silvia Martini  1 , Margherita Saracco  1 , Donatella Cocchis  2 , Fabrizia Pittaluga  3 , Bruna Lavezzo  4 , Francesca Barisone  5 , Luigi Chiusa  6 , Antonio Amoroso  7 , Massimo Cardillo  8 , Paolo A Grossi  9 , Renato Romagnoli  2
Affiliations

Favorable experience of transplant strategy including liver grafts from COVID-19 donors: One-year follow-up results

Silvia Martini et al. Transpl Infect Dis. 2023 Oct.

Abstract

Background: Since November 2020, Italy was the first country to carry out a protocol and use liver from COVID-19 donors. We aimed to evaluate the medium-term outcome of patients who underwent liver transplant (LT) with those grafts.

Methods: We consecutively enrolled 283 patients who underwent first LT from November 2020 to December 2022 in our Center (follow-up 468 days). Twenty-five of 283 (8.8%, study population) received a graft from donors with previous (4%) or active (96%) SARS-CoV-2 infection, and 258/283 (91.2%, control group) received a graft from COVID-19-negative donors. SARS-CoV-2-RNA was tested on graft tissue of COVID-19 donors and their recipients underwent weekly evaluation of SARS-CoV-2-RNA in nasal swabs for the first month after LT.

Results: One-year and 2-year patient survival was 88.5% and 88.5% in study group versus 94.5% and 93.5% in control group, respectively (p = .531). In study population there was no evidence of donor-recipient virus transmission, but three (12%) patients (vs. 7 [2.7%] of control group, p = .048) developed hepatic artery thrombosis (HAT): they were SARS-CoV-2-RNA negative at LT and 1/3 grafts tested SARS-CoV-2-RNA positive on liver tissue. COVID-19 donor was independently associated with HAT (odds ratio (OR) = 4.85, 95% confidence interval (CI) 1.10-19.15; p = .037). By comparing study population with control group, acute rejection and biliary complication rates were not significantly different (16% vs. 8.1%, p = .26; 16% vs. 16.3% p = .99, respectively).

Conclusions: Our 1-year results of transplant strategy including liver grafts from COVID-19 donors were favorable. HAT was the only complication with significantly higher rate in patients transplanted with COVID-19 donors compared with control group.

Keywords: COVID-19 donors; cholangiopathy; follow-up; hepatic artery thrombosis; liver transplant.

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References

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