Impact and management of COVID-19 in liver transplant candidates and recipients

Abstract

The COVID-19 outbreak has had severe consequences for global public health, medical communities, and the socioeconomic status of a considerable number of countries. The emergence of COVID-19 has also significantly impacted the world of liver transplantation (LT). Studies from transplantation centers around the world have shown that LTs during the COVID-19 pandemic have been restricted because of the high risk of serious COVID-19 infection in this population. According to the Centers for Disease Control and Prevention, patients with liver disease are considered at higher risk for severe COVID-19 infection. In March 2020, the American Association for the Study of Liver Diseases recommended that LT should be limited to emergency cases. The COVID-19 treatment guidelines published by the National Institutes of Health are being constantly updated according to new epidemiology trends and treatment regimens. Immunocompromised patients have a higher risk of developing severe disease or death from COVID-19 compared with the general population. In this review, we summarize the available evidence regarding treatment guidelines and considerations for the evaluation and management of LT candidates and recipients in the era of COVID-19. In addition, we present data regarding COVID-19 among LT patients in our local transplantation center.

Keywords: COVID-19; SARS-CoV-2; chronic liver disease; liver transplantation; vaccination.

Figure 1

Solid organ transplantations performed in the Transplantation Center in Thessaloniki Greece

Figure 2

Vaccination schedule against COVID-19 for immunocompromised patients

Figure 3

(A) Treatment guidance for non-hospitalized LT patients with COVID-19, (B) treatment guidance for hospitalized LT patients with COVID-19 LT, liver transplantation; mTOR, mammalian target of rapamycin; LMWH, low molecular weight heparin; IL-6, interleukin-6; JAK, Janus kinase