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1.
Exp Clin Transplant ; 19(11): 1232-1237, 2021 11.
Article in English | MEDLINE | ID: covidwho-1431093

ABSTRACT

Shortages of grafts for liver transplant remain a persistent problem. The use of lacerated livers for liver transplant can add an option for extended criteria donations, especially during the COVID-19 pandemic. We present the case of a successful liver transplant performed using a high-grade lacerated liver previously treated with superselective arterial embolization and packing for bleeding control. In view of the absence of guidelines for the use of lacerated livers for transplant, we also performed a review of the literature on injured liver grafts that were used for liver transplants. Meticulous care and careful selection of recipients were essential prerequisites for achieving successful outcomes.


Subject(s)
Abdominal Injuries/etiology , COVID-19 , End Stage Liver Disease/surgery , Heart Massage/adverse effects , Liver Transplantation , Liver/injuries , Liver/surgery , Myocardial Infarction/therapy , Takotsubo Cardiomyopathy/complications , Abdominal Injuries/diagnostic imaging , Abdominal Injuries/therapy , Adolescent , Adult , Clinical Decision-Making , Donor Selection , End Stage Liver Disease/diagnosis , Fatal Outcome , Female , Humans , Liver/diagnostic imaging , Liver Transplantation/adverse effects , Male , Middle Aged , Myocardial Infarction/diagnosis , Myocardial Infarction/etiology , Risk Assessment , Risk Factors , Takotsubo Cardiomyopathy/diagnosis , Treatment Outcome , Young Adult
2.
Exp Clin Transplant ; 19(2): 160-162, 2021 02.
Article in English | MEDLINE | ID: covidwho-1033040

ABSTRACT

Liver transplant is a lifesaving treatment option for end-stage liver disease in those with or without hepatocellular carcinoma. Organ shortage is currently the main limitation to liver transplant in many countries worldwide, with fewer donors than patients waiting for transplant. Different solutions have been proposed, including the use of marginal grafts, living donors, and machine perfusion. Potential organs are sometimes discarded due to technical difficulties that may hamper the success of their retrieval and eventual transplant. Here, we present the case of a 69-year-old man with a history of cardiac and pulmonary disease who was considered a potential organ donor after brain death. According to the patient's history, a computed tomography before acceptance was required. The scan revealed a giant thoracoabdominal aortic aneurysm. The donor had previous cardiac surgery with sternotomy and a talcage of the right pleural space. The 2 renal arteries were also unusable because of spread calcifications and involvement by the aneurism. We decided to cannulate the superior mesenteric vessels. Liver transplant was uneventful, and the recipient had no vascular complications, as shown by Doppler ultrasonography performed on days 1, 3, and 7. Length of hospitalization was 14 days. Organ shortages for transplant seemed to have worsened during the COVID-19 period. Nonetheless, the condition of oncology patients can worsen if surgical treatments are delayed. Rearrangements of resources require adaptations in clinical practice.


Subject(s)
Aortic Aneurysm, Thoracic , Donor Selection , Liver Transplantation , Tissue and Organ Procurement , Aged , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/pathology , COVID-19 , Humans , Male
3.
Medicine (Baltimore) ; 99(41): e22174, 2020 Oct 09.
Article in English | MEDLINE | ID: covidwho-841113

ABSTRACT

Coronavirus disease 2019 (COVID-19) is challenging health care systems worldwide, raising the question of reducing the transplant program due to the shortage of intensive care unit beds and to the risk of infection in donors and recipients.We report the positive experience of a single Transplant Center in Rome, part of the National Institute for Infectious Diseases Lazzaro Spallanzani, one of the major national centers involved in the COVID-19 emergency.


Subject(s)
Coronavirus Infections , Liver Transplantation/statistics & numerical data , Pandemics , Pneumonia, Viral , COVID-19 , Hospitals/statistics & numerical data , Humans , Italy
4.
Hepatol Int ; 14(5): 621-637, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-671930

ABSTRACT

BACKGROUND AND AIMS: Coronavirus disease 2019 (COVID-19) pandemic is ongoing. Except for lung injury, it is possible that COVID-19 patients develop liver injury. Thus, we conducted a systematic review and meta-analysis to explore the incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID-19 patients. METHODS: PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang databases were searched. The incidence of abnormal liver biochemical tests, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), total bilirubin (TBIL), and albumin (ALB), was pooled. Risk ratio (RR) was calculated to explore the association of abnormal liver biochemical tests with severity and prognosis of COVID-19 patients. RESULTS: Forty-five studies were included. The pooled incidence of any abnormal liver biochemical indicator at admission and during hospitalization was 27.2% and 36%, respectively. Among the abnormal liver biochemical indicators observed at admission, abnormal ALB was the most common, followed by GGT, AST, ALT, TBIL, and ALP (39.8%, 35.8%, 21.8%, 20.4%, 8.8%, and 4.7%). Among the abnormal liver biochemical indicators observed during hospitalization, abnormal ALT was more common than AST and TBIL (38.4%, 28.1%, and 23.2%). Severe and/or critical patients had a significantly higher pooled incidence of abnormal liver biochemical indicators at admission than mild and/or moderate patients. Non-survivors had a significantly higher incidence of abnormal liver biochemical indicators than survivors (RR = 1.34, p = 0.04). CONCLUSIONS: Abnormal liver biochemical tests are common in COVID-19 patients. Liver biochemical indicators are closely related to the severity and prognosis of COVID-19 patients.


Subject(s)
Coronavirus Infections , Critical Care , Hepatic Insufficiency , Liver Function Tests/methods , Pandemics , Pneumonia, Viral , COVID-19 , Coronavirus Infections/blood , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Critical Care/methods , Critical Care/statistics & numerical data , Hepatic Insufficiency/diagnosis , Hepatic Insufficiency/epidemiology , Hepatic Insufficiency/virology , Humans , Incidence , Pneumonia, Viral/blood , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Prognosis , Risk Assessment/methods
5.
Updates Surg ; 72(2): 281-289, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-526853

ABSTRACT

COVID-19 is rapidly spreading worldwide. Healthcare systems are struggling to properly allocate resources while ensuring cure for diseases outside of the infection. The aim of this study was to demonstrate how surgical activity was affected by the virus outbreak and show the changes in practice in a tertiary referral COVID-19 center. The official bulletins of the Italian National Institute for the Infectious Diseases "L. Spallanzani" were reviewed to retrieve the number of daily COVID-19 patients. Records of consecutive oncological and transplant procedures performed during the outbreak were reviewed. Patients with a high probability of postoperative intensive care unit (ICU) admission were considered as high risk and defined by an ASA score ≥ III and/or a Charlson Comorbidity Index (CCI) ≥ 6 and/or a Revised Cardiac Risk Index for Preoperative Risk (RCRI) ≥ 3. 72 patients were operated, including 12 (16.6%) liver and kidney transplantations. Patients had few comorbidities (26.3%), low ASA score (1.9 ± 0.5), CCI (3.7 ± 1.3), and RCRI (1.2 ± 0.6) and had overall a low risk of postoperative ICU admission. Few patients had liver cirrhosis (12.5%) or received preoperative systemic therapy (16.6%). 36 (50%) high-risk surgical procedures were performed, including major hepatectomies, pancreaticoduodenectomies, total gastrectomies, multivisceral resections, and transplantations. Despite this, only 15 patients (20.8%) were admitted to the ICU. Only oncologic cases and transplantations were performed during the COVID-19 outbreak. Careful selection of patients allowed to perform major cancer surgeries and transplantations without further stressing hospital resources, meanwhile minimizing collateral damage to patients.


Subject(s)
Coronavirus Infections , Kidney Transplantation/statistics & numerical data , Liver Transplantation/statistics & numerical data , Neoplasms/surgery , Pandemics , Pneumonia, Viral , Tertiary Care Centers , Aged , COVID-19 , Female , Humans , Italy , Male , Middle Aged , Surgical Procedures, Operative/statistics & numerical data , Time Factors
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