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1.
BMJ Open Gastroenterol ; 8(1)2021 10.
Article in English | MEDLINE | ID: covidwho-1476450

ABSTRACT

BACKGROUND: COVID-19 pandemic has globally affected healthcare including the transplantation programmes. MATERIALS AND METHODS: We retrospectively studied the impact of COVID-19 on live liver donor (LLD) programme at liver transplant centre in Gambat, Pakistan. Standard operative procedures (SOPs) including COVID-19 nasopharyngeal swab PCR, CT scans, personal protective equipment use, 6-feet distancing were developed for LLD and transplant team to mitigate COVID-19 exposure. We compared the complications, healthcare utilisation (hospital stay, readmission) and mortality between two LLD cohorts-before and during COVID-19 pandemic from March 2019 to December 2020. RESULTS: During study period 300 LLD surgeries were performed. There was an increase in rate of LLDs from 132 (44%) in pre-COVID to 168 (56%) during COVID-19 era. Average numbers of transplants per month performed during pre-COVID and during COVID-19 era were 10.1 and 14, respectively. No donor has developed COVID-19 infection during hospitalisation. Rate of all LLD complications (32 (21.47%) and 49 (29.16%), p=0.43), uneventful discharges (120/168 (71.4%) and 88/132 (66.6%), p<0.05), mean hospital stay (6±2 days and 5±2 days, p=0.17) and readmission (5 (4%) and 3 (1.8%), p=0.43) were similar during the pre-COVID and COVID-19 era. No donor mortality was observed during study period. CONCLUSION: With the implementation of mindful SOPs, rate of LLD increased without any case of COVID-19 infection. Our SOPs were helpful in continuation of LLD programme in a developing country during COVID-19 pandemic.


Subject(s)
COVID-19 , Pandemics , Humans , Liver , Living Donors , Pakistan/epidemiology , Retrospective Studies , SARS-CoV-2
2.
JAMA ; 326(11): 1007-1008, 2021 Sep 21.
Article in English | MEDLINE | ID: covidwho-1439647
5.
BMJ Case Rep ; 14(8)2021 Aug 26.
Article in English | MEDLINE | ID: covidwho-1376467

ABSTRACT

Since identified in December 2019, COVID-19 has remained a pandemic across the globe. Although primarily a respiratory illness, the impact of COVID-19 on other end organs has been increasingly identified. The effect of COVID-19 on the liver has yet to be completely understood. We describe a case of COVID-19 leading to end-stage cholangiopathy and deceased donor liver transplantation (LT). A 64-year-old man with no underlying respiratory or liver disease presented with acute respiratory distress secondary to COVID-19 pneumonia requiring intubation. Several months after resolution of his respiratory symptoms, he developed transaminitis, worsening jaundice, abdominal pain and dark-coloured urine. Hepatic function remained severely impaired warranting LT 259 days following his initial COVID-19 diagnosis. Explant pathology demonstrated diffuse hepatic injury, onion skinning of the bile ducts and bile duct loss in scattered portal tracts. As more patients develop COVID-19-related complications, we suggest LT as an option for COVID-19-related end-stage liver disease.


Subject(s)
COVID-19 , Cholangitis, Sclerosing , Liver Transplantation , COVID-19 Testing , Cholangitis, Sclerosing/complications , Cholangitis, Sclerosing/surgery , Humans , Living Donors , Male , Middle Aged , SARS-CoV-2
6.
Int J Clin Pract ; 75(8): e14324, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1338805

ABSTRACT

AIM: To analyze developing infections after living donor hepatectomy (LDH) in living liver donors (LLDs). METHODS: Demographic and clinical characteristics of 1106 LLDs were retrospectively analyzed in terms of whether postoperative infection development. Therefore, LLDs were divided into two groups: with (n = 190) and without (n = 916) antimicrobial agent use. RESULTS: The median age was 29.5 (min-max: 18-55). A total of 257 (23.2%) infection attacks (min-max: 1-8) was developed in 190 (17.2%) LLDs. The patients with the infection that were longer intensive care unit (ICU) and hospital stays, higher hospital admissions, emergency transplantation, invasive procedures for ERCP, PTC biloma, and abscess drainage, and the presence of relaparatomies and transcystic catheters. Infection attacks are derived from a 58.3% hepatobiliary system, 13.2% urinary system, 6.6% surgical site, and 5.8% respiratory system. The most common onset symptoms were fever, abdominal pain, nausea, and vomiting. A total of 125 positive results was detected from 77 patients with culture positivity. The most detected microorganisms from the cultures taken are Extended-Spectrum ß-lactamases (ESBL) producing Klebsiella pneumonia (16.8%) and Escherichia coli (16%), Methicillin-Resistant Staphylococcus aureus [(MRSA) (9.6%)], Methicillin-susceptible S aureus [(MSSA) (9.6%)], and Pseudomonas aeruginosa (8.8%), respectively. The average number of ICU hospitalization days was 3 ± 2 (min 1-max 30, IQR:1) and hospitalization days was 14 ± 12 (min 3-max 138, IQR: 8). All infection attacks were successfully treated. No patients died because of infection or another surgical complication. CONCLUSION: Infections commonly observed infected biloma, cholangitis, and abscess arising from the biliary system and other nosocomial infections are the feared complications in LLDs. These infections should be managed multidisciplinary without delay and carefully.


Subject(s)
Cross Infection , Methicillin-Resistant Staphylococcus aureus , Staphylococcal Infections , Adult , Anti-Bacterial Agents/therapeutic use , Cross Infection/drug therapy , Humans , Liver , Living Donors , Retrospective Studies , Staphylococcal Infections/drug therapy
7.
Clin Transplant ; 35(9): e14394, 2021 09.
Article in English | MEDLINE | ID: covidwho-1338800

ABSTRACT

BACKGROUND: To gather information on long-term outcomes after living donation, the Scientific Registry of Transplant Recipients (SRTR) conducted a pilot on the feasibility of establishing a comprehensive donor candidate registry. METHODS: A convenience sample of 6 US living liver donor programs evaluated 398 consecutive donor candidates in 2018, ending with the March 12, 2020, COVID-19 emergency. RESULTS: For 333/398 (83.7%), the donor or program decided whether to donate; 166/333 (49.8%) were approved, and 167/333 (50.2%) were not or opted out. Approval rates varied by program, from 27.0% to 63.3% (median, 46%; intraquartile range, 37.3-51.1%). Of those approved, 90.4% were white, 57.2% were women, 83.1% were < 50 years, and 85.5% had more than a high school education. Of 167 candidates, 131 (78.4%) were not approved or opted out because of: medical risk (10.7%); chronic liver disease risk (11.5%); psychosocial reasons (5.3%); candidate declined (6.1%); anatomical reasons increasing recipient risk (26.0%); recipient-related reasons (33.6%); finances (1.5%); or other (5.3%). CONCLUSIONS: A comprehensive national registry is feasible and necessary to better understand candidate selection and long-term outcomes. As a result, the US Health Resources and Services Administration asked SRTR to expand the pilot to include all US living donor programs.


Subject(s)
COVID-19 , Living Donors , Female , Humans , Liver , Registries , SARS-CoV-2
9.
Clin Transplant ; 35(8): e14292, 2021 08.
Article in English | MEDLINE | ID: covidwho-1249408

ABSTRACT

To predict whether the COVID-19 pandemic and transplant center responses could have resulted in preventable deaths, we analyzed registry information of the US end-stage renal disease (ESRD) patient population awaiting kidney transplantation. Data were from the Organ Procurement and Transplantation Network (OPTN), the US Centers for Disease Control and Prevention, and the United States Renal Data System. Based on 2019 OPTN reports, annualized reduction in kidney transplantation of 25%-100% could result in excess deaths of wait-listed (deceased donor) transplant candidates from 84 to 337 and living donor candidate excess deaths from 35 to 141 (total 119-478 potentially preventable deaths of transplant candidates). Changes in transplant activity due to COVID-19 varied with some centers shutting down while others simply heeded known or suspected pandemic risks. Understanding potential excess mortality for ESRD transplant candidates when circumstances compel curtailment of transplant activity may inform policy and procedural aspects of organ transplant systems allowing ways to best inform patients and families as to potential risks in shuttering organ transplant activity. Considering that more than 700 000 Americans have ESRD with 100 000 awaiting a kidney transplant, our highest annual estimate of 478 excess total deaths from postponing kidney transplantation seems modest.


Subject(s)
COVID-19 , Kidney Failure, Chronic , Tissue and Organ Procurement , Humans , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/surgery , Living Donors , Pandemics , SARS-CoV-2 , United States/epidemiology , Waiting Lists
15.
Transplant Proc ; 53(4): 1105-1111, 2021 May.
Article in English | MEDLINE | ID: covidwho-1118702

ABSTRACT

During the coronavirus 2019 pandemic we converted our liver transplant waitlist candidate education and support program to a virtual format and expanded it to include ongoing engagement sessions aimed to educate and empower patients to maximize opportunity for live donor liver transplantation. Over a period of 6 months from April 2020 to Sept 2020 we included 21 patients in this pilot quality improvement program. We collected data regarding patient response and potential donor referral activity. Overall, patient response was positive, and some patients saw progress toward live donor liver transplantation by fostering inquiry of potential live liver donors. Optimization of logistical aspects of the program including program flow, technology access, and utilization is required to enhance patient experience. Long-term follow-up is needed to assess impact on the outcome of transplantation rates. Future data collection and analysis should focus on assessment of any potential disparity that may result from utilization of virtual programming. Herein we provide a framework for this type of virtual program and describe our experience.


Subject(s)
COVID-19 , Liver Transplantation/education , Living Donors/education , Patient Education as Topic/methods , Telemedicine/methods , Adult , Female , Humans , Male , Pilot Projects , Program Evaluation , Quality Improvement , Referral and Consultation , SARS-CoV-2
16.
Clin J Gastroenterol ; 14(3): 842-845, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1118282

ABSTRACT

The outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in 2019; thereafter, the COVID-19 outbreak became a health emergency of international concern. The impact of COVID-19 on liver-transplant recipients is unclear. Thus, it is currently unknown whether liver-transplant recipients are at a higher risk of developing complications related to COVID-19. Here, we report the case of liver-transplant recipients who were infected with SARS-CoV-2. A 20-year-old man who had undergone living-donor liver transplantation from his father at 5 years of age because of congenital biliary atresia was referred to our hospital for SARS-CoV-2 infection. Chest computed tomography did not show any abnormalities; however, laboratory results revealed liver dysfunction. He received tacrolimus as maintenance therapy that was continued at the same dose. He has not developed severe pulmonary disease and was discharged after 10 days of hospitalization. Limited data are available on post-transplant patients with COVID-19, and this case of a young patient without metabolic comorbidities did not show any association of severe COVID-19 under tacrolimus treatment. The progression of COVID-19 in liver-transplant recipients is complex, and COVID-19 risk should be evaluated in each patient until the establishment of optimal guidelines.


Subject(s)
COVID-19/diagnosis , Immunosuppressive Agents/therapeutic use , Liver Transplantation/adverse effects , Postoperative Complications/drug therapy , SARS-CoV-2/isolation & purification , Tacrolimus/therapeutic use , Adult , COVID-19 Testing , Humans , Immunocompromised Host , Living Donors , Male , Postoperative Complications/diagnosis , Postoperative Complications/etiology , SARS-CoV-2/immunology , Transplant Recipients , Treatment Outcome , Young Adult
18.
Cell Tissue Bank ; 22(4): 703-709, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1092050

ABSTRACT

Bone banks are necessary for providing biological allografts for a series of orthopedic procedures. As nations cope with new realities driven by the 2019 coronavirus disease (COVID-19) pandemic, health-care providers, institutions, and patients share a particular concern about the effect of COVID-19 on organ donation and transplantation. Here, we describe the management of the Kitasato University Bone Bank during the state of emergency declared in response to COVID-19. Living donors received pre-operative screening by PCR, and allograft bone from COVID-19-negative donors was cryopreserved as transplantable tissues. The weekly rate of infection gradually increased from February 2-9 to April 5-11 in the dead donor-derived allograft bone-harvesting region covered by the Bank. It is becoming clear that the virus can be transmitted by asymptomatic patients, and that this route may have facilitated the spread of COVID-19. Therefore, the Bank stopped dead donor donation to consider the safety of medical staff. Three recipients received bone allografts following pre-operative COVID-19 screening by PCR. All patients were asymptomatic after bone allograft. Our experience may provide helpful information for the management of tissue banks.


Subject(s)
Bone Banks , COVID-19 , Humans , Japan , Living Donors , SARS-CoV-2
20.
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
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