Transplant center graz guidelines for liver transplantation during covid-19 pandemic

ABSTRACT

Introduction: The new coronavirus type 2 is responsible for severe acute respiratory syndrome (SARS-CoV-2). The associated disease named Coronavirus Disease 2019 (COVID-19) has spread around the world within a few weeks. Its impact on solid organ transplantation is largely unknown. It can be only assumed that immunosuppression is related with an increase of COVID-19 related morbidity and mortality. Here we describe our Transplant Center Graz guidelines including all preventive measures taken to protect liver transplant recipients from infection during COVID-19 pandemic. Methods: COVID-19 evaluation of donors and recipients comprises epidemiological and clinical evaluation as well as nasal swab COVID-19-PCR testing. An important part of the in hospital recipient management is a special training of both the whole transplant team and the recipient on protective measures against COVID-19 infection. The recipient is isolated in a single bed overpressure room with airlock including private rest room with shower for the recipient. Furthermore, strict visit ban consists and a restricted number of persons is allowed to be in the same room with the patient after transplantation (n=2). Members of the transplant team and the recipient wear ffp2 masks when they are together. It is aimed for fast extubation, fast step down from ICU to IMC / normal ward and rapid hospital discharge. The outpatient care includes phone consulting, immunomonitoring with blood samples drawn at home and sent to our center and limited social contacts to an absolute minimum. Results: During COVID-19 pandemic, LT was safely performed based on our experience and none of the patients transplanted during this time (n=4) got sick from COVID-19. Conclusion: Requirements for a safe procedure during COVID-19 pandemic are (i) a low-risk setting (both donor and recipient COVID-19 negative), (ii) internal Transplant Center Graz guidelines (described above) in combination with (iii) low disease severity recipients (labMELD score 10-14) of a low donor risk index graft.