ABSTRACT
Introduction: Novel coronavirus affects different individuals in different ways, with most people recovering with mild to moderate illness not requiring hospitalization. Liver transplant for end-stage liver disease is a lifesaving procedure, and though living donor liver transplant (LDLT) is a well-planned elective surgery, it was considered a semi-emergency owing to the decompensation of the recipient posing a challenge to the transplant team owing to the situation of the pandemic. The availability of liver grafts from cadaveric donors in India was 0.65 per million population until 2019 as per the National Organ and Tissue Transplant Organization statistics which was sparse and further accentuated, leaving LDLT as the only option during the pandemic. Aim: This study aims to describe our experience and testing protocol for COVID-19 disease for the patients undergoing liver transplant during the pandemic at our hospital, which is a tertiary care referral hospital. Materials and Methods: This was a retrospective study done at AIG Hospitals, Hyderabad, India. Fifty adult patients who underwent LDLT and deceased donor liver transplant from May 2020 to December 2020 were included in the study. Exclusion Criteria: All recipients and donors with reverse transcription polymerase chain reaction (RT-PCR) positive for SARS CoV2;and COVID-19 disease reporting and data system (CO-RADS) score of 4 or 5 on high-resolution computed tomography (HRCT) chest. Results: The mean age of the recipients was 46 years, and the donors was 36 years;the most common indication being acute-on-chronic liver failure with failed medical therapies and the second common being hepatocellular carcinoma. All the 50 recipients were RT-PCR negative for SARS CoV2;8 out of whom had a CO-RADS score of 3;and 4 out of the 8 were post-COVID-19 infection who had IgG positive and IgM negative;and the other 4 were both IgG and IgM negative, similarly 4 out of 8 donors were IgG positive. Intraoperative and postoperative period was uneventful. None of the donors or recipients were infected with COVID-19 disease during the hospital stay and up to 1 month postoperative. One patient died within 1 month due to sudden cardiac arrest. Conclusion: In our experience, with meticulous testing and proper care, there is a favorable outcome for liver transplant even during the pandemic.
ABSTRACT
INTRODUCTION AND OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic continues to be a global health crisis despite the recent worldwide vaccine distribution. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is most commonly believed to cause severe disease manifestations secondary to a cytokine storm. Low testosterone is associated with a proinflammatory environment and it is thought that a eugonadal testosterone level may be protective of increased cytokine activity. Objective: In this study, we explore the association between baseline testosterone level and COVID-19 clinical outcomes. METHODS: Through a retrospective chart review, we identified 188 males from an academic health system in a metropolitan area diagnosed with COVID-19 with measured baseline testosterone levels who were not on testosterone replacement therapy. The 188 males were divided into eugonadal (n=90, >300 ng/dL) and hypogonadal (n=98, ≤300 ng/dL) testosterone groups. Data regarding comorbidities and endpoints such as hospital admission, intensive care unit admission, ventilator utilization, and thromboembolic events were extracted. Chi-square and Fisher's Exact tests examined differences in categorical variables. Logistic regression analysis tested the relationship between testosterone level and endpoints. RESULTS: There were 188 men identified who met our inclusion criteria. There were 90 men in the eugonadal group and 98 men in the hypogonadal group. Median age (IQR) was 55 (43-67) for the eugonadal group and 55 (40-63) for the hypogonadal group, median BMI was 30.6 (27.7-35.4) and 31.3 (26.4-35.6), and median testosterone level was 396 (357-476.3 ng/dL) and 217 (141.3 - 255 ng/dL) for the two groups respectively. Hypogonadism was significantly related to hospital admission (p=0.027). While not statistically significant, there were more ICU admissions (p=0.75), ventilator use (p=0.75), and DVTs seen in the hypogonadal group. On logistic regression analysis, hypogonadism was predictive of hospital admission (p=0.021). CONCLUSIONS: Eugonadal testosterone level may be protective of more severe clinical outcomes in COVID-19. Hypogonadism is associated with increased hospital admission. Further research with a larger sample size needs to be conducted to fully understand the relationship between testosterone and clinical outcomes in COVID-19.
ABSTRACT
INTRODUCTION AND OBJECTIVE: Continued vigilance of operative outcomes of COVID-19 patients is important given the relative novelty of the SARS-CoV-2 infection. We here sought to evaluate the 30-day mortality and cardiopulmonary adverse event rates in patients undergoing emergency surgery with perioperative COVID-19 infection, in comparison to a control group of medically managed COVID-19 patients that did not require surgical intervention. METHODS: A retrospective review of electronic medical data from a single tertiary-care center in Michigan was undertaken. Patients who had tested positive for SARS-CoV-2 infection either 7 days before or within 30 days after surgery during March-May 2020 were included in the study (n=52). Propensity score matched (1:6) patients who had been positive for SARS-CoV-2 infection during this time-period but did not undergo surgery were used as controls (n=314, Figure 1). The primary endpoint was 30-day mortality. Secondary endpoints included cardiac and pulmonary complications. Multivariable logistic regression analyses were utilized to account for baseline differences. A pvalue <0.05 was considered significant. RESULTS: The 30-day mortality (17.3% vs 13.1%, p=0.408) and cardiac (28.9% vs 19.1%, p=0.107) and pulmonary complication (55.8% vs 49.4%, p=0.392) rates were similar in patients in the surgical versus non-surgical group, respectively. Multivariable analyses confirmed that an emergency surgical intervention was not associated with increased odds for any of the studied adverse events (p >0.10 for all 3 endpoints). CONCLUSIONS: Patients undergoing emergency surgery with a co-diagnosis of SARS-CoV-2 infection in the perioperative period do not have an increased risk for short-term mortality or cardiopulmonary complications compared to the medically treated COVID-19 patients.