Liver transplantation for acute liver failure in a SARS-CoV-2 PCR-positive patient.
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 phosphatasebilirubin ratio <4, ASTALT 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.
Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Liver Transplantation
/
Liver Failure, Acute
/
COVID-19
Type of study:
Case report
/
Prognostic study
Limits:
Adolescent
/
Female
/
Humans
Language:
English
Journal:
Am J Transplant
Journal subject:
Transplantation
Year:
2021
Document Type:
Article
Affiliation country:
Ajt.16582
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