ABSTRACT
Background: SARS-CoV2 is a novel betacoronavirus that was first noted Wuhan, Hubei Province, China in late December 2019 This virus is the causative agent of COVID-19 and has rapidly spread across the globe The impact of this novel virus on the transplant community is under rapid investigation Previous studies involving the 2003 SARS-CoV and MERSCoV infections have demonstrated to apparent increase in mortality for solid organ transplant recipient Outcome data in solid organ transplant is currently limited although data from the United States and Europe suggesting that overall survival may be affected There is additional ambiguity in the impact of COVID-19 infection in the immediate post-transplant period In this communication, we describe a case of a patient who was infected with SARS-CoV2 within 3 months of orthotopic liver transplantation The clinical and therapeutic course will be described in detail Methods: This is a retrospective case report All data was obtained from the electronic medical record Results: The patient is a 47-year-old female with a history of multi-focal HCC treated with surgical and loco-regional therapy who underwent liver transplantation February 11th, 2020 Her post-operative course was complicated by early bile leak requiring re-do biliary anastomosis and surgical biliary stent placement She underwent the institutional standard steroid and basiliximab induction therapy She underwent a semi-elective ERCP with biliary stent removal April 3rd, 2020 The patient developed upper respiratory symptoms and diarrhea 3 days prior to admission and was diagnosed with COVID-19 on April 20th, 2020 in the hospital Oxygen saturation was 93% on admission although her oxygen requirement peaked at 5L nasal cannula Hydroxychloroquine was started per institutional guidelines along with ceftriaxone/ doxycycline for superimposed bacterial pneumonia Full dose mycophenolate mofetil was held The mean tacrolimus level during the hospitalization 10 4 Starting hospital day 3, the patient was started on compassionate use remdesivir daily given worsening pulmonary status followed by one dose of convalescent plasma on hospital day 4 The patient's symptoms gradually improved and she was discharged on hospital day 9 without home oxygen Conclusion: This case demonstrates the feasibility and efficacy of remdesivir and convalescent plasma in the immediate post liver transplant period These experimental drugs that have shown modest benefit based on recently unpublished data in the general population but has not been described in a liver transplant recipient It was also noted that tacrolimus pharmacokinetics were affected causing elevated tacrolimus levels during periods of worsening inflammatory symptoms. The mechanism of this change has never been described in the recent literature and will need to be addressed in future studies.