Liver transplant during COVID-19 pandemic: A tertiary care center retrospective study

ABSTRACT

Introduction: Novel coronavirus affects different individuals in different ways, with most people recovering with mild to moderate illness not requiring hospitalization. Liver transplant for end-stage liver disease is a lifesaving procedure, and though living donor liver transplant (LDLT) is a well-planned elective surgery, it was considered a semi-emergency owing to the decompensation of the recipient posing a challenge to the transplant team owing to the situation of the pandemic. The availability of liver grafts from cadaveric donors in India was 0.65 per million population until 2019 as per the National Organ and Tissue Transplant Organization statistics which was sparse and further accentuated, leaving LDLT as the only option during the pandemic. Aim: This study aims to describe our experience and testing protocol for COVID-19 disease for the patients undergoing liver transplant during the pandemic at our hospital, which is a tertiary care referral hospital. Materials and Methods: This was a retrospective study done at AIG Hospitals, Hyderabad, India. Fifty adult patients who underwent LDLT and deceased donor liver transplant from May 2020 to December 2020 were included in the study. Exclusion Criteria All recipients and donors with reverse transcription polymerase chain reaction (RT-PCR) positive for SARS CoV2;and COVID-19 disease reporting and data system (CO-RADS) score of 4 or 5 on high-resolution computed tomography (HRCT) chest. Results: The mean age of the recipients was 46 years, and the donors was 36 years;the most common indication being acute-on-chronic liver failure with failed medical therapies and the second common being hepatocellular carcinoma. All the 50 recipients were RT-PCR negative for SARS CoV2;8 out of whom had a CO-RADS score of 3;and 4 out of the 8 were post-COVID-19 infection who had IgG positive and IgM negative;and the other 4 were both IgG and IgM negative, similarly 4 out of 8 donors were IgG positive. Intraoperative and postoperative period was uneventful. None of the donors or recipients were infected with COVID-19 disease during the hospital stay and up to 1 month postoperative. One patient died within 1 month due to sudden cardiac arrest. Conclusion: In our experience, with meticulous testing and proper care, there is a favorable outcome for liver transplant even during the pandemic.