ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic has upended healthcare systems worldwide and led to an inevitable decrease in liver transplantation (LT) activity. During the first pandemic wave, administrators and clinicians were obliged to make the difficult decision of whether to suspend or continue a life-saving procedure based on the scarce available evidence regarding the risk of transmission and mortality in immunosuppressed patients. Those centers where the activity continued or was heavily restricted were obliged to screen donors and recipients, design COVID-safe clinical pathways, and promote telehealth to prevent nosocomial transmission. Despite the ever-growing literature on COVID-19, the amount of high-quality literature on LT remains limited. This review will provide an updated view of the impact of the pandemic on LT programs worldwide. Donor and recipient screening, strategies for waitlist prioritization, and posttransplant risk of infection and mortality are discussed. Moreover, a particular focus is given to the possibility of donor-to-recipient transmission and immunosuppression management in COVID-positive recipients.
Subject(s)
COVID-19/epidemiology , Liver Transplantation/trends , Tissue and Organ Procurement/trends , COVID-19/diagnosis , COVID-19/transmission , Disease Transmission, Infectious/prevention & control , Graft vs Host Disease/prevention & control , Health Care Rationing , Humans , Immunosuppressive Agents/therapeutic use , Mass Screening , SARS-CoV-2 , Transplants/virologySubject(s)
Antiviral Agents/therapeutic use , COVID-19 , Carcinoma, Hepatocellular/surgery , Immunocompromised Host/immunology , Immunosuppressive Agents , Liver Transplantation , Antiviral Agents/classification , COVID-19/complications , COVID-19/immunology , COVID-19/therapy , Carcinoma, Hepatocellular/pathology , Female , Humans , Immunosuppressive Agents/immunology , Immunosuppressive Agents/therapeutic use , Liver Neoplasms/pathology , Liver Neoplasms/surgery , Liver Transplantation/adverse effects , Liver Transplantation/methods , Middle Aged , SARS-CoV-2/isolation & purification , Time , Treatment OutcomeABSTRACT
Although immunosuppressed patients may be more prone to SARS-CoV-2 infection with atypical presentation, long-term immunosuppression therapy may provide some sort of protection for severe clinical complications of COVID-19. The interaction between immunosuppression and new antiviral drugs in the treatment of transplanted patients contracting COVID-19 has not yet been fully investigated. Moreover, data regarding the optimal management of these patients are still very limited. We report a case of the successful recovery from severe COVID-19 of a kidney-transplanted patient treated with hydroxychloroquine, lopinavir/ritonavir, steroid, and tocilizumab.