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1.
Liver Transpl ; 27(9): 1312-1325, 2021 09.
Article in English | MEDLINE | ID: covidwho-1336025

ABSTRACT

Over the last year, the novel coronavirus disease 2019 (COVID-19) has continued to spread across the globe, causing significant morbidity and mortality among transplantation candidates and recipients. Patients with end-stage liver disease awaiting liver transplantation and patients with a history of liver transplantation represent vulnerable populations, especially given the high rates of associated medical comorbidities in these groups and their immunosuppressed status. In addition, concerns surrounding COVID-19 risk in this patient population have affected rates of transplantation and general transplantation practices. Here, we explore what we have learned about the impact of COVID-19 on liver transplantation candidates and recipients as well as the many key knowledge gaps that remain.


Subject(s)
COVID-19 , End Stage Liver Disease , Liver Transplantation , End Stage Liver Disease/epidemiology , End Stage Liver Disease/surgery , Humans , Liver Transplantation/adverse effects , Pandemics , SARS-CoV-2
2.
Am J Gastroenterol ; 116(7): 1414-1425, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1229490

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 virus, is a predominantly respiratory tract infection with the capacity to affect multiple organ systems. Abnormal liver tests, mainly transaminase elevations, have been reported in hospitalized patients. We describe a syndrome of cholangiopathy in patients recovering from severe COVID-19 characterized by marked elevation in serum alkaline phosphatase (ALP) accompanied by evidence of bile duct injury on imaging. METHODS: We conducted a retrospective study of COVID-19 patients admitted to our institution from March 1, 2020, to August 15, 2020, on whom the hepatology service was consulted for abnormal liver tests. Bile duct injury was identified by abnormal liver tests with serum ALP > 3x upper limit of normal and abnormal findings on magnetic resonance cholangiopacreatography. Clinical, laboratory, radiological, and histological findings were recorded in a Research Electronic Data Capture database. RESULTS: Twelve patients were identified, 11 men and 1 woman, with a mean age of 58 years. Mean time from COVID-19 diagnosis to diagnosis of cholangiopathy was 118 days. Peak median serum alanine aminotransferase was 661 U/L and peak median serum ALP was 1855 U/L. Marked elevations of erythrocyte sedimentation rate, C-reactive protein, and D-dimers were common. Magnetic resonance cholangiopacreatography findings included beading of intrahepatic ducts (11/12, 92%), bile duct wall thickening with enhancement (7/12, 58%), and peribiliary diffusion high signal (10/12, 83%). Liver biopsy in 4 patients showed acute and/or chronic large duct obstruction without clear bile duct loss. Progressive biliary tract damage has been demonstrated radiographically. Five patients were referred for consideration of liver transplantation after experiencing persistent jaundice, hepatic insufficiency, and/or recurrent bacterial cholangitis. One patient underwent successful living donor liver transplantation. DISCUSSION: Cholangiopathy is a late complication of severe COVID-19 with the potential for progressive biliary injury and liver failure. Further studies are required to understand pathogenesis, natural history, and therapeutic interventions.


Subject(s)
COVID-19/complications , Cholangitis, Sclerosing/epidemiology , End Stage Liver Disease/epidemiology , Jaundice/epidemiology , Adult , Aged , Alanine Transaminase/blood , Alkaline Phosphatase/blood , Bile Ducts/diagnostic imaging , Bile Ducts/immunology , Bile Ducts/pathology , Biopsy , COVID-19/diagnosis , COVID-19/immunology , COVID-19/virology , COVID-19 Nucleic Acid Testing , Cholangiopancreatography, Magnetic Resonance , Cholangitis, Sclerosing/diagnosis , Cholangitis, Sclerosing/immunology , Cholangitis, Sclerosing/therapy , Disease Progression , End Stage Liver Disease/diagnosis , End Stage Liver Disease/immunology , End Stage Liver Disease/surgery , Female , Humans , Jaundice/diagnosis , Jaundice/immunology , Jaundice/therapy , Liver Function Tests , Liver Transplantation , Male , Middle Aged , Prognosis , Retrospective Studies , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Severity of Illness Index
3.
Transplant Proc ; 53(4): 1132-1137, 2021 May.
Article in English | MEDLINE | ID: covidwho-1180075

ABSTRACT

Liver injury is one of the nonpulmonary manifestations described in coronavirus disease 2019 (COVID-19). Post-COVID-19 cholangiopathy is a special entity of liver injury that has been suggested as a variant of secondary sclerosing cholangitis in critically ill patients (SSC-CIP). In the general population, the outcome of SSC-CIP has been reported to be poor without orthotopic liver transplantation (OLT). However, the role of OLT for post-COVID-19 cholangiopathy is unknown. We present a case report of a 47-year-old man who recovered from acute respiratory distress syndrome from COVID-19 and subsequently developed end-stage liver disease from post-COVID-19 cholangiopathy. The patient underwent OLT and is doing well with normal liver tests for 7 months. To our knowledge, this is the first case report of a patient who underwent successful liver transplantation for post-COVID-19 cholangiopathy.


Subject(s)
COVID-19/complications , End Stage Liver Disease/surgery , Liver Transplantation , SARS-CoV-2 , COVID-19/surgery , End Stage Liver Disease/virology , Humans , Liver/surgery , Liver/virology , Male , Middle Aged
4.
Pediatr Transplant ; 25(5): e13986, 2021 08.
Article in English | MEDLINE | ID: covidwho-1124666

ABSTRACT

The COVID-19 pandemic has proven to be a challenge in regard to the clinical presentation, prevention, diagnosis, and management of SARS-CoV-2 infection among children who are candidates for and recipients of SOT. By providing scenarios and frequently asked questions encountered in routine clinical practice, this document provides expert opinion and summarizes the available data regarding the prevention, diagnosis, and management of SARS-CoV-2 infection among pediatric SOT candidates and recipients and highlights ongoing knowledge gaps requiring further study. Currently available data are still lacking in the pediatric SOT population, but data have emerged in both the adult SOT and general pediatric population regarding the approach to COVID-19. The document provides expert opinion regarding prevention, diagnosis, and management of SARS-CoV-2 infection among pediatric SOT candidates and recipients.


Subject(s)
COVID-19/complications , End Stage Liver Disease/surgery , Liver Transplantation/adverse effects , Lung Transplantation/adverse effects , SARS-CoV-2 , Transplant Recipients , Adolescent , Child , Child, Preschool , False Positive Reactions , Female , Humans , Immunocompromised Host , Male , Organ Transplantation , Pandemics , Patient Safety , Postoperative Period , Reproducibility of Results , Reverse Transcriptase Polymerase Chain Reaction , Risk , Risk Factors
6.
J Gastrointest Cancer ; 52(3): 1143-1147, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1086672

ABSTRACT

Coronavirus 2019 (COVID-19) is a new infectious disease that continues to spread globally. There is growing concern about donor-induced transmission of Coronavirus 2 (SARS -CoV-2). For liver transplantation, the COVID-19 PCR test is routine, in addition to epidemiological history and clinical and radiological examination 24-48 h before surgery. One of the liver transplant candidates was found to be infected with COVID-19, as well as the planned donor candidate. Since COVID-19 will be a high-risk operation for both the recipient and the donor, the operation was postponed by giving medical treatment. After the treatment and quarantine process was over, the patient and the donor then had a negative COVID-19 PCR test and the patient received a living donor liver transplant. We present a case of donor and recipient who initially both tested positive for COVID-19. This liver transplantation scenario has not previously been reported in the literature.


Subject(s)
COVID-19/prevention & control , Donor Selection/standards , Liver Transplantation/adverse effects , Living Donors , Postoperative Complications/prevention & control , Adult , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/transmission , End Stage Liver Disease/surgery , Humans , Liver Transplantation/standards , Male , Middle Aged , Postoperative Complications/virology , Postoperative Period , Preoperative Period , SARS-CoV-2/isolation & purification , Treatment Outcome
9.
Am J Transplant ; 21(4): 1629-1632, 2021 04.
Article in English | MEDLINE | ID: covidwho-852163

ABSTRACT

To date, little is known about the duration and effectiveness of immunity as well as possible adverse late effects after an infection with SARS-CoV-2. Thus it is unclear, when and if liver transplantation can be safely offered to patients who suffered from COVID-19. Here, we report on a successful liver transplantation shortly after convalescence from COVID-19 with subsequent partial seroreversion as well as recurrence and prolonged shedding of viral RNA.


Subject(s)
Antibodies, Viral/blood , COVID-19/complications , End Stage Liver Disease/surgery , Liver Transplantation , Virus Shedding , COVID-19/pathology , Humans , Male , Middle Aged , RNA, Viral/genetics , SARS-CoV-2 , Severity of Illness Index
10.
Transpl Infect Dis ; 23(2): e13492, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-840560

ABSTRACT

Transplantation in potential candidates who have recently recovered from COVID-19 is a challenge with uncertainties regarding the diagnosis, multi-organ systemic involvement, prolonged viral shedding in immunocompromised patients, and optimal immunosuppression. A 42 year male with alcoholic hepatitis underwent a successful deceased donor liver transplantation 71 days after the initial diagnosis of COVID-19. At the time of transplant, he was SARS-CoV-2 PCR negative for 24 days and had a MELD score of 33. His post-operative course was complicated by acute rejection which responded to intense immune-suppression using T-cell depletion and steroids. He was discharged with normal end-organ function and no evidence of any active infection including COVID-19. Prospective organ transplant recipients who have recovered from COVID-19 can be considered for transplantation after careful pre-transplant evaluation, donor selection, and individualized risk-benefit analysis.


Subject(s)
COVID-19/therapy , End Stage Liver Disease/surgery , Graft Rejection/prevention & control , Hepatitis, Alcoholic/surgery , Immunosuppressive Agents/therapeutic use , Liver Transplantation , Acute Disease , Adult , Antilymphocyte Serum/therapeutic use , COVID-19/complications , End Stage Liver Disease/complications , Glucocorticoids/therapeutic use , Graft Rejection/drug therapy , Hepatitis, Alcoholic/complications , Humans , Immunization, Passive , Male , SARS-CoV-2 , Severity of Illness Index
11.
Intern Emerg Med ; 15(8): 1507-1515, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-802945

ABSTRACT

Transplant programs have been severely disrupted by the COVID-19 pandemic. Italy was one of the first countries with the highest number of deaths in the world due to SARS-CoV-2. Here we propose a management model for the reorganization of liver transplant (LT) activities and policies in a local intensive care unit (ICU) assigned to liver transplantation affected by restrictions on mobility and availability of donors and recipients as well as health personnel and beds. We describe the solutions implemented to continue transplantation activities throughout a given pandemic: management of donors and recipients' LT program, ICU rearrangement, healthcare personnel training and monitoring to minimize mortality rates of patients on the waiting list. Transplantation activities from February 22, 2020, the data of first known COVID-19 case in Italy's Emilia Romagna region to June 30, 2020, were compared with the corresponding period in 2019. During the 2020 study period, 38 LTs were performed, whereas 41 were performed in 2019. Patients transplanted during the COVID-19 pandemic had higher MELD and MELD-Na scores, cold ischaemia times, and hospitalization rates (p < 0.05); accordingly, they spent fewer days on the waitlist and had a lower prevalence of hepatocellular carcinoma (p < 0.05). No differences were found in the provenance area, additional MELD scores, age of donors and recipients, BMI, re-transplant rates, and post-transplant mortality. No transplanted patients contracted COVID-19, although five healthcare workers did. Ultimately, our policy allowed us to continue the ICU's operations by prioritizing patients hospitalized with higher MELD without any case of transplant infection due to COVID-19.


Subject(s)
Critical Care/methods , Liver Transplantation/methods , Pandemics/statistics & numerical data , Adult , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Critical Care/trends , Crowding , End Stage Liver Disease/complications , End Stage Liver Disease/epidemiology , End Stage Liver Disease/surgery , Female , Humans , Intensive Care Units/organization & administration , Intensive Care Units/statistics & numerical data , Italy/epidemiology , Liver Transplantation/standards , Liver Transplantation/statistics & numerical data , Male , Middle Aged , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology
14.
Lancet Gastroenterol Hepatol ; 5(11): 1008-1016, 2020 11.
Article in English | MEDLINE | ID: covidwho-733560

ABSTRACT

BACKGROUND: Despite concerns that patients with liver transplants might be at increased risk of adverse outcomes from COVID-19 because of coexisting comorbidities and use of immunosuppressants, the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on this patient group remains unclear. We aimed to assess the clinical outcomes in these patients. METHODS: In this multicentre cohort study, we collected data on patients with laboratory-confirmed SARS-CoV-2 infection, who were older than 18 years, who had previously received a liver transplant, and for whom data had been submitted by clinicians to one of two international registries (COVID-Hep and SECURE-Cirrhosis) at the end of the patient's disease course. Patients without a known hospitalisation status or mortality outcome were excluded. For comparison, data from a contemporaneous cohort of consecutive patients with SARS-CoV-2 infection who had not received a liver transplant were collected from the electronic patient records of the Oxford University Hospitals National Health Service Foundation Trust. We compared the cohorts with regard to several outcomes (including death, hospitalisation, intensive care unit [ICU] admission, requirement for intensive care, and need for invasive ventilation). A propensity score-matched analysis was done to test for an association between liver transplant and death. FINDINGS: Between March 25 and June 26, 2020, data were collected for 151 adult liver transplant recipients from 18 countries (median age 60 years [IQR 47-66], 102 [68%] men, 49 [32%] women) and 627 patients who had not undergone liver transplantation (median age 73 years [44-84], 329 [52%] men, 298 [48%] women). The groups did not differ with regard to the proportion of patients hospitalised (124 [82%] patients in the liver transplant cohort vs 474 [76%] in the comparison cohort, p=0·106), or who required intensive care (47 [31%] vs 185 [30%], p=0·837). However, ICU admission (43 [28%] vs 52 [8%], p<0·0001) and invasive ventilation (30 [20%] vs 32 [5%], p<0·0001) were more frequent in the liver transplant cohort. 28 (19%) patients in the liver transplant cohort died, compared with 167 (27%) in the comparison cohort (p=0·046). In the propensity score-matched analysis (adjusting for age, sex, creatinine concentration, obesity, hypertension, diabetes, and ethnicity), liver transplantation did not significantly increase the risk of death in patients with SARS-CoV-2 infection (absolute risk difference 1·4% [95% CI -7·7 to 10·4]). Multivariable logistic regression analysis showed that age (odds ratio 1·06 [95% CI 1·01 to 1·11] per 1 year increase), serum creatinine concentration (1·57 [1·05 to 2·36] per 1 mg/dL increase), and non-liver cancer (18·30 [1·96 to 170·75]) were associated with death among liver transplant recipients. INTERPRETATION: Liver transplantation was not independently associated with death, whereas increased age and presence of comorbidities were. Factors other than transplantation should be preferentially considered in relation to physical distancing and provision of medical care for patients with liver transplants during the COVID-19 pandemic. FUNDING: European Association for the Study of the Liver, US National Institutes of Health, UK National Institute for Health Research.


Subject(s)
Coronavirus Infections , Intensive Care Units/statistics & numerical data , Liver Transplantation , Pandemics , Pneumonia, Viral , Betacoronavirus/isolation & purification , COVID-19 , Cohort Studies , Comorbidity , Coronavirus Infections/blood , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Creatinine/analysis , End Stage Liver Disease/surgery , Female , Hospitalization/statistics & numerical data , Humans , Liver Transplantation/methods , Liver Transplantation/statistics & numerical data , Male , Middle Aged , Outcome and Process Assessment, Health Care , Pneumonia, Viral/blood , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Registries/statistics & numerical data , Respiration, Artificial/statistics & numerical data , Risk Factors , SARS-CoV-2 , Survival Analysis
15.
J Hepatol ; 73(4): 873-881, 2020 10.
Article in English | MEDLINE | ID: covidwho-701738

ABSTRACT

BACKGROUND & AIMS: The outbreak of COVID-19 has vastly increased the operational burden on healthcare systems worldwide. For patients with end-stage liver failure, liver transplantation is the only option. However, the strain on intensive care facilities caused by the pandemic is a major concern. There is an urgent need for ethical frameworks to balance the need for liver transplantation against the availability of national resources. METHODS: We performed an international multicenter study of transplant centers to understand the evolution of policies for transplant prioritization in response to the pandemic in March 2020. To describe the ethical tension arising in this setting, we propose a novel ethical framework, the quadripartite equipoise (QE) score, that is applicable to liver transplantation in the context of limited national resources. RESULTS: Seventeen large- and medium-sized liver transplant centers from 12 countries across 4 continents participated. Ten centers opted to limit transplant activity in response to the pandemic, favoring a "sickest-first" approach. Conversely, some larger centers opted to continue routine transplant activity in order to balance waiting list mortality. To model these and other ethical tensions, we computed a QE score using 4 factors - recipient outcome, donor/graft safety, waiting list mortality and healthcare resources - for 7 countries. The fluctuation of the QE score over time accurately reflects the dynamic changes in the ethical tensions surrounding transplant activity in a pandemic. CONCLUSIONS: This four-dimensional model of quadripartite equipoise addresses the ethical tensions in the current pandemic. It serves as a universally applicable framework to guide regulation of transplant activity in response to the increasing burden on healthcare systems. LAY SUMMARY: There is an urgent need for ethical frameworks to balance the need for liver transplantation against the availability of national resources during the COVID-19 pandemic. We describe a four-dimensional model of quadripartite equipoise that models these ethical tensions and can guide the regulation of transplant activity in response to the increasing burden on healthcare systems.


Subject(s)
Coronavirus Infections/epidemiology , End Stage Liver Disease , Health Resources/trends , Liver Transplantation , Pandemics , Pneumonia, Viral/epidemiology , Tissue and Organ Procurement , Betacoronavirus , COVID-19 , End Stage Liver Disease/mortality , End Stage Liver Disease/surgery , Humans , International Cooperation , Liver Transplantation/ethics , Liver Transplantation/methods , Organizational Innovation , Pandemics/ethics , Pandemics/prevention & control , Patient Selection/ethics , SARS-CoV-2 , Surveys and Questionnaires , Tissue and Organ Procurement/ethics , Tissue and Organ Procurement/organization & administration , Tissue and Organ Procurement/trends , Waiting Lists/mortality
16.
Acta Gastroenterol Belg ; 83(2): 340-343, 2020.
Article in English | MEDLINE | ID: covidwho-625874

ABSTRACT

Since January 2020, the Novel Coronavirus Disease 2019 (COVID-19) pandemic has dramatically impacted the world. In March 2020, the COVID-19 epidemic reached Belgium creating uncertainty towards all aspects of life. There has been an impressive capacity and solidarity of all healthcare professionals to acutely reconvert facilities to treat these patients. In the context of liver transplantation (LTx), concerns are raised about organ donation shortage and safety, the ethics of using limited healthcare resources for LTx, selection criteria for LTx during the epidemic and the risk of de novo COVID-19 infection on the waiting list and after LTx. BeLIAC makes several recommendations to try to mitigate the deleterious effect that this epidemic has/will have on donation and LTx, taking into account the available resources, and trying to maximize patients and healthcare professionals' safety.


Subject(s)
Coronavirus Infections , End Stage Liver Disease/surgery , Infection Control/methods , Liver Transplantation/methods , Pandemics , Pneumonia, Viral , Belgium , Betacoronavirus , COVID-19 , Coronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , End Stage Liver Disease/epidemiology , Humans , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , SARS-CoV-2
17.
Am J Transplant ; 20(7): 1840-1848, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-617768

ABSTRACT

In January 2020, Novel Coronavirus Disease 2019 (COVID-19) resulted in a global pandemic, creating uncertainty toward the management of liver transplantation (LT) programs. Lombardy has been the most affected region in Italy: the current mortality rate of COVID-19 patients is 18.3% (10 022 deaths; April 10th) with hospitals in Lombardy having to expand the total number of ICU beds from 724 to 1381 to accommodate infected patients. There has been a drastic decrease in liver donors. From February 23rd until April 10th, 17 LTs were performed in Lombardy. Mean donor age was 49 years (range 18-74) whereas mean recipient age was 55 (13-69); mean MELD score was 12 (6-24). All donors underwent screening for SARS-CoV-2 prior to LT. Two patients tested positive after LT, and one patient died for COVID on POD 30. Sixteen patients are alive after an average of 30 days post-LT (range 3-46). 10 patients have been discharged. This study has found no specific reason concerning the safety of recipients, to stop LT programs. Several key lessons from our experience are reported. However, due to the complex circumstances which surround the viral outbreak, the cessation or a reduction in LT activity is a pragmatic requirement.


Subject(s)
Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , End Stage Liver Disease/surgery , Liver Transplantation/trends , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Adolescent , Adult , Aged , Betacoronavirus , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , End Stage Liver Disease/complications , Female , Follow-Up Studies , Humans , Italy/epidemiology , Male , Middle Aged , Prognosis , SARS-CoV-2 , Tissue Donors , Tissue and Organ Procurement , Treatment Outcome , Young Adult
18.
Transpl Infect Dis ; 22(5): e13384, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-610833

ABSTRACT

COVID-19 is now a pandemic with increasing numbers of cases and deaths. In addition to the economic and social damage caused by COVID-19 outbreak prolongation, damage caused by delayed treatment of other diseases such as severe cirrhosis is also serious. We aimed to describe the effect of COVID-19 on the number of liver transplants (LT) in South Korea. The number of LT performed in Korea during the Middle East Respiratory Syndrome (MERS) outbreak, and the COVID-19 pandemic was compared with the average number of LT performed in the past 5 years. There were 108.5 cases of LT performed per month during the MERS outbreak. It was 11% lower than the average of 122.8 cases per month for the last 5 years. LDLT and DDLT decreased by 13% to 75.3 cases and by 7.5% to 33.2 cases per month during the MERS epidemic, respectively. From January to March 2020 (COVID-19 outbreak), the number of LT did not decrease significantly. The lockdown caused by COVID-19 did not affect the number of liver transplants in Korea. Establishing a safe process and procedure of liver transplantation within safe boundaries can be beneficial in reducing the side effects of lockdown and saving patients' lives.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control/standards , Coronavirus Infections/prevention & control , End Stage Liver Disease/surgery , Liver Transplantation/statistics & numerical data , COVID-19/epidemiology , COVID-19/transmission , COVID-19/virology , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , End Stage Liver Disease/mortality , Humans , Liver Transplantation/methods , Liver Transplantation/standards , Living Donors/statistics & numerical data , Middle East Respiratory Syndrome Coronavirus/pathogenicity , Pandemics/prevention & control , Republic of Korea/epidemiology , SARS-CoV-2/pathogenicity , Waiting Lists/mortality
19.
Arab J Gastroenterol ; 21(2): 69-75, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-355730

ABSTRACT

Liver transplantation is considered the ultimate solution for patients with end-stage chronic liver disease or acute liver failure. Patients with liver transplant need special care starting from preoperative preparation, surgical intervention ending with postoperative care. Transplanted patients have to receive immunosuppressive therapy to prevent rejection. Such a state of immune suppression could predispose to different types of infections in liver transplant recipients. Currently, the world is suffering a pandemic caused by a new strain of the coronavirus family called COVID-19. Certain infection control precautions are needed to protect immunocompromised and vulnerable patients, including liver transplant candidates and recipients from acquiring COVID-19 infection. Restricting non-transplant elective surgical procedures, managing transplant patients in separate outpatient clinics, and in-patient wards can prevent transmission of infection both to patients and healthcare workers. Telemedicine can help in the triage of patients to screen for symptoms of COVID-19 before their regular appointment. Management of immunosuppressive therapy and drug-drug interactions in liver transplant recipients infected with COVID-19 should be cautiously practiced to prevent rejection and effectively treat the underlying infection. In this report, we are trying to summarize available evidence about different aspects of the management of liver transplant candidates and recipients in the era of COVID-19.


Subject(s)
Coronavirus Infections , Disease Transmission, Infectious/prevention & control , End Stage Liver Disease , Infection Control/methods , Liver Failure, Acute , Liver Transplantation/methods , Pandemics , Pneumonia, Viral , Betacoronavirus/isolation & purification , COVID-19 , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , End Stage Liver Disease/epidemiology , End Stage Liver Disease/surgery , Humans , Liver Failure, Acute/epidemiology , Liver Failure, Acute/surgery , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , SARS-CoV-2
20.
Am J Transplant ; 20(7): 1885-1890, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-116579

ABSTRACT

With the rapidly expanding pandemic of SARS-CoV-2, there is concern that solid organ transplant recipients will be particularly vulnerable to infection and may experience a more severe clinical course. We report four cases of COVID-19 in solid organ transplant recipients including recipients of kidney, liver, lung, and heart transplants. We describe each patient's medical history including transplantation history, their clinical presentation and workup, and their course from diagnosis to either hospital discharge or to improvement in symptoms. These reports demonstrate a range of symptoms, clinical severity, and disease course in solid organ transplant recipients with COVID-19, including two hospitalized patients and two patients managed entirely in the outpatient setting.


Subject(s)
Coronavirus Infections/complications , Pneumonia, Viral/complications , Transplant Recipients , Aged , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , End Stage Liver Disease/complications , End Stage Liver Disease/surgery , Female , Heart Failure/complications , Heart Failure/surgery , Heart Transplantation , Hospitalization , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/surgery , Kidney Transplantation , Liver Transplantation , Lung Diseases/complications , Lung Diseases/surgery , Lung Transplantation , Male , Middle Aged , Outpatients , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , United States/epidemiology , Vulnerable Populations , Washington
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