Liver transplantation during COVID 19 pandemic: The LDLT perspective

ABSTRACT

Background: COVID 19 pandemic has affected the healthcare system worldwide and Liver transplantation(LT) has been no exception. Live Donor Liver Transplantation(LDLT) during the COVID 19 pandemic has been controversial in terms of donor and recipient safety and the risk of infection with COVID 19 . The study was done to assess the safety and outcomes of LDLT during COVID 19 pandemic. Methods: Retrospective analysis of patients undergoing LT during COVID 19 pandemic was done . Preoperative characteristics and post operative outcomes, complications and survival was noted. Results: A total of 94 patients underwent LT since the beginning of COVID pandemic out of which 87(92.5 %) were LDLT out of which 71 were adults and 16 were paediatric recipients. The mean age of the patients was 38.4 years (6 months - 66 years) with an average Model for End stage Liver Disease (MELD Na) score of 25.3, with chronic liver disease(CLD) being the most common indication for LT(74%) and ethanol being the most common etiology for liver disease(31%). The rate of major complications (Grade III/IV Clavein Dindo classification) was 27.6% and the mortality rate in LDLT for CLD, Acute on chronic liver failure (ACLF) and Acute liver failure (ALF) was 4.2%, 11.1% and 38.5% respectively. There was only 1(1.1%) recipient who developed COVID 19 infection in the post operative period. The donors had a complication rate of 4.5 % and 0 mortality with there being no episode of COVID 19 infection in the perioperative period in the donors. There were 5 recipients and 2 donors who underwent LDLT and donor hepatectomy after recovering from COVID 19 infection. The rate of complication, hospital stay, day of extubation were similar to patients without history of COVID 19 infection. There was a 65 % decrease in the LT activity during the first wave of COVID 19 infection as compared to the average in previous years whereas after the end of the first wave, there was a 24% increase in the LT activity in that period as compared to previous years. Conclusion: For patients undergoing LDLT during COVID 19 pandemic, the complication rate and overall survival was comparable to the pre COVID era. The rate of COVID 19 infection in the perioperative period was minimal. With proper screening of the patients and following of COVID 19 protocols, LDLT is safe in COVID 19 era and must be continued.