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1.
Exp Clin Transplant ; 20(3): 285-292, 2022 03.
Article in English | MEDLINE | ID: covidwho-1771685

ABSTRACT

OBJECTIVES: With the declaration of the COVID-19 pandemic and the increased COVID-19 risk shown in transplant recipients, the prevalence, clinical course, and outcomes of COVID-19 infections among liver transplant recipients were assessed. MATERIALS AND METHODS: A questionnaire was designed and used to survey medical services for liver transplant recipients seen at our center in terms of COVID-19 infection. RESULTS: Twenty-five patients infected with COVID-19 were identified from 265 liver transplant recipients. Most patients were male and had COVID-19 despite quarantine at home. All patients received modified immunosuppressive drugs during infection with COVID-19 with minor changes in routine immunosuppressive therapy. Among the identified patients, 21 recovered and 4 patients died. One of the dead patients, in addition to having a liver transplant, had brain cancer with metastasis to the lungs. CONCLUSIONS: In liver transplant recipients infected with COVID-19, immunosuppressive drugs seemed to cause only mild to moderate illnesses or even helped them recover from the disease. However, more evidence is needed to prove this hypothesis. It is also recommended that transplant recipients should be warned about personal hygiene and be monitored closely by organ transplant centers.


Subject(s)
COVID-19 , Kidney Transplantation , Liver Transplantation , Humans , Immunosuppressive Agents/adverse effects , Iran/epidemiology , Kidney Transplantation/adverse effects , Liver Transplantation/adverse effects , Male , Pandemics , Registries , SARS-CoV-2 , Transplant Recipients , Treatment Outcome
5.
World J Gastroenterol ; 27(44): 7734-7738, 2021 Nov 28.
Article in English | MEDLINE | ID: covidwho-1573671

ABSTRACT

The recent manuscript reviewed investigations involving liver damage in coronavirus disease 2019 (COVID-19) patients, and COVID-19 in patients with previous chronic hepatological diseases, such as patients with liver graft. The literature presents several conflicting results concerning the anti-SARS-CoV-2 response in patients with solid organ transplants, in liver transplant recipients. Therefore, we would like to humbly state a few points for consideration involving liver transplant recipients and COVID-19, such as the time since transplantation, comorbidities, and immunosuppressive regimens.


Subject(s)
COVID-19 , Liver Transplantation , Organ Transplantation , Humans , Liver Transplantation/adverse effects , SARS-CoV-2 , Transplant Recipients
6.
Liver Transpl ; 28(2): 215-223, 2022 02.
Article in English | MEDLINE | ID: covidwho-1568241

ABSTRACT

The BNT162b2 messenger RNA (mRNA) vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been shown to be safe and effective in immunocompetent patients. The safety and efficacy of this vaccine in liver transplantation (LT) recipients is still under evaluation. The objective of this study was to assess the safety and efficacy of the BNT162b2 vaccine among transplant recipients. The immune responses of 76 LT recipients receiving 2 doses of the vaccine were compared with those of 174 age-matched immunocompetent controls. Postvaccination immunoglobulin G (IgG) antibodies against the receptor-binding domain (RBD) of SARS-CoV-2 and neutralizing antibodies (NA) to the BNT162b2 mRNA vaccine were determined at least 14 days after the second dose of the vaccine. IgG antibody titers ≥1.1 were defined as positive antibodies. Adverse effects were monitored during the study period. Following administration of the second dose, transplant recipients showed reduced immune responses compared with controls (72% versus 94.2%; P < 0.001). At a median time of 38 days after the second vaccination, the geometric mean of RBD IgG and NA titers were 2.1 (95% confidence interval [CI], 1.6-2.6) and 150 (95% CI, 96-234) among transplant recipients and 4.6 (95% CI, 4.1-5.1) and 429 (95% CI, 350-528) in the control group, respectively (P < 0.001). Antibody responses were lower in transplant recipients who were receiving combined immunosuppression therapy and in those with impaired renal function. Among the LT recipients with negative antibody responses, 1 became infected with SARS-CoV-2, but no recipients with positive antibody responses became infected. Overall, most (n = 39 [51%]) adverse effects self-reported by transplant recipients were mild and occurred more often in women than in men. Compared with patients who were immunocompetent, LT recipients had lower immune responses. The durability of immune responses to the BNT162b2 vaccine among LT recipients requires further investigation.


Subject(s)
COVID-19 , Liver Transplantation , Antibodies, Viral , COVID-19 Vaccines , Female , Humans , Liver Transplantation/adverse effects , Male , RNA, Messenger/genetics , SARS-CoV-2 , Transplant Recipients , Vaccines, Synthetic
9.
Transplant Proc ; 53(4): 1126-1131, 2021 May.
Article in English | MEDLINE | ID: covidwho-1525970

ABSTRACT

Coronavirus disease 2019 drastically impacted solid organ transplantation. Lacking scientific evidence, a very stringent but safer policy was imposed on liver transplantation (LT) early in the pandemic. Restrictive transplant guidelines must be reevaluated and adjusted as data become available. Before LT, the prevailing policy requires a negative severe acute respiratory syndrome coronavirus 2 real-time polymerase chain reaction (RT-PCR) of donors and recipients. Unfortunately, prolonged viral RNA shedding frequently hinders transplantation. Recent data reveal that positive test results for viral genome are frequently due to noninfectious and prolonged convalescent shedding of viral genome. Moreover, studies demonstrated that the cycle threshold of quantitative RT-PCR could be leveraged to inform clinical transplant decision-making. We present an evidence-adjusted and significantly less restrictive policy for LT, where risk tolerance is tiered to recipient acuity. In addition, we delineate the pretransplant clinical decision-making, intra- and postoperative management, and early outcome of 2 recipients of a liver graft performed while their RT-PCR of airway swabs remained positive. Convalescent positive RT-PCR results are common in the transplant arena, and the proposed policy permits reasonably safe LT in many circumstances.


Subject(s)
COVID-19 Nucleic Acid Testing/standards , COVID-19/diagnosis , Health Policy , Liver Transplantation/legislation & jurisprudence , SARS-CoV-2/genetics , COVID-19/prevention & control , COVID-19 Nucleic Acid Testing/methods , Female , Humans , Infection Control/legislation & jurisprudence , Infection Control/methods , Liver Transplantation/adverse effects , Male , Middle Aged , Postoperative Complications/prevention & control , Postoperative Complications/virology , Preoperative Care/legislation & jurisprudence , Preoperative Care/methods , Reference Values , Tissue Donors , Virus Shedding
10.
Transpl Infect Dis ; 24(1): e13757, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1501505

ABSTRACT

On April 2021, the United States Organ Procurement and Transplantation Executive Committee approved the "lower respiratory SARS-CoV-2 testing for lung donors" emergency policy upon recommendation from the Ad Hoc Disease Transmission Advisory Committee. This policy requires that all lung donors be tested for SARS-CoV-2 in a lower respiratory specimen by nucleic acid test (NAT) and that the results be available before the lungs are transplanted. The overarching goal of the emergency policy was to minimize the risk of donor-derived COVID-19 to lung recipients. However, an unintended consequence of the policy was the emergence of a new population of potential donors: the SARS-CoV-2 lower respiratory tract (LRT) NAT positive donor. We describe the use of two SARS-CoV-2 LRT NAT positive liver donors without a known history of COVID-19 infection with adequate short-term outcomes. The recipients did not have a prior history of COVID-19, nor did they receive monoclonal antibodies post-transplantation; one was unvaccinated. If the safety and long-term outcomes from SARS-CoV-2 LRT NAT positive donors are confirmed in larger studies, this strategy represents a promising way to increase the pool for organ donation.


Subject(s)
COVID-19 , Liver Transplantation , Nucleic Acids , COVID-19 Testing , Humans , Liver Transplantation/adverse effects , SARS-CoV-2 , Tissue Donors , United States , Uronic Acids
11.
Liver Transpl ; 28(2): 180-187, 2022 02.
Article in English | MEDLINE | ID: covidwho-1490858

ABSTRACT

Chronic liver disease increased the risk of severe coronavirus disease 2019 (COVID-19). Trials to assess efficacy/safety of COVID-19 vaccines in liver disease are underway. We evaluated the humoral immune response and safety of anti-COVID-19 vaccination among patients waiting liver transplantation (LT). We enrolled all pre-LT adults who completed anti-COVID-19 vaccination between January 2021-August 2021 as study group. Patients with histories of COVID-19 received 1 vaccine dose, and all others received 2 doses. Patients were tested for COVID-19 immunoglobulin G (IgG) within 1 and 2 months after vaccination. Safety was evaluated with telephone interviews/outpatient visits. A control group of 30 healthcare workers who underwent vaccination in January 2021 and tested for IgG after 4 months was included. In the 89 pre-LT patients, at T1 (23 days after vaccination), seroconversion rate was 94.4%, and median IgG value was 1980 binding antibody units/mL (interquartile range 646-2080), and at T2 (68 days after vaccination) was 92.0%, with IgG value of 1450 (577-2080); (T1 versus T2, P = 0.38). In the 10/89 patients who received 1 vaccine dose, the median IgG value was 274 (68-548) before vaccine (T0), 2080 (1165-2080) at T1, and 2030 (964-2080) at T2 (T0 versus T1, P = 0.03; T1 versus T2, P = 0.99). All controls tested positive at 4 months after vaccination, with a median value of 847 (509-1165; P < 0.001 versus T1 and P = 0.04 versus T2 in the study group). No serious adverse event was reported in both groups. Our data from 89 pre-LT patients suggest a high rate of immunization (94.4%) after a median time of 23 days from safe COVID-19 vaccine. None of the patients developed COVID-19.


Subject(s)
COVID-19 , Liver Transplantation , Adult , Antibodies, Viral , COVID-19 Vaccines , Humans , Liver Transplantation/adverse effects , SARS-CoV-2 , Seroconversion , Vaccination
12.
Rev Esp Enferm Dig ; 114(3): 174-175, 2022 03.
Article in English | MEDLINE | ID: covidwho-1478755

ABSTRACT

Symptoms of COVID-19 ranging from mild to severe and pulmonary manifestations are the most common. However, liver injury is not rare as there might be a reciprocal influence between COVID-19 and hepatic disease. While high levels of liver enzymes are associated with an increased prevalence of severe complications, the search for other etiologies of hepatic disease should be not be ignored. We report a case of COVID-19 that presented with acute fulminant hepatitis A (HAV) without a previous history.


Subject(s)
COVID-19 , Hepatitis A , Liver Failure, Acute , Liver Transplantation , COVID-19/complications , Hepatitis A/complications , Humans , Liver Transplantation/adverse effects
15.
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
17.
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
19.
Am J Transplant ; 21(8): 2890-2894, 2021 08.
Article in English | MEDLINE | ID: covidwho-1297494

ABSTRACT

Current guidelines recommend deferring liver transplantation (LT) in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection until clinical improvement occurs and two PCR tests collected at least 24 hours apart are negative. We report a case of an 18-year-old, previously healthy African-American woman diagnosed with COVID-19, who presents with acute liver failure (ALF) requiring urgent LT in the context of SARS-CoV-2 polymerase chain reaction (PCR) positivity. The patient was thought to have acute Wilsonian crisis on the basis of hemolytic anemia, alkaline phosphatase:bilirubin ratio <4, AST:ALT ratio >2.2, elevated serum copper, and low uric acid, although an unusual presentation of COVID-19 causing ALF could not be excluded. After meeting criteria for status 1a listing, the patient underwent successful LT, despite ongoing SARS-CoV-2 PCR positivity. Remdesivir was given immediately posttransplant, and mycophenolate mofetil was withheld initially and the SARS-CoV-2 PCR test eventually became negative. Three months following transplantation, the patient has made a near-complete recovery. This case highlights that COVID-19 with SARS-CoV-2 PCR positivity may not be an absolute contraindication for transplantation in ALF. Criteria for patient selection and timing of LT amid the COVID-19 pandemic need to be validated in future studies.


Subject(s)
COVID-19 , Liver Failure, Acute , Liver Transplantation , Adolescent , Female , Humans , Liver Failure, Acute/etiology , Liver Failure, Acute/surgery , Liver Transplantation/adverse effects , Pandemics , Polymerase Chain Reaction , SARS-CoV-2
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