Covid-19 in recipients of living donor liver transplantation: a worse or an equivalent outcome?

BACKGROUND: Coronavirus disease 2019 (Covid-19) pandemic is representing a massive burden to the community with the new virus. There is few data regarding Covid-19 in liver transplant patients. Concerns were raised regarding the course of the disease in transplanted patients due to immunosuppression and risk of hepatic injuries. AIM: To describe the outcomes of Covid-19 infection in recipients of living-donor liver transplantation (LDLT). METHODS: Retrospective analysis of 41 recipients of LDLT diagnosed with Covid-19 by real-time PCR or CT chest criteria of Covid-19 between April 2020 and April 2021. This Cohort was derived from Ain Shams Center for Organ Transplantation database, Ain Shams Specialized Hospital, Cairo, Egypt, which is considered one of the largest centers of LDLT in the Middle East. Patients were classified to mild, moderate, severe and critics according to clinical classification released by the National Health Commission of China. RESULTS: A total of 41 patients and 2 patients with reinfection were included in this cohort with mean age 54 years with 74% male and 26% female. The body mass index ranged from 19.3 to 37. About 30% were described as a mild case, 46.5% were moderate, 14% were severe and 9% were critical cases. Two cases developed infection twice. Total of 20 patients (46.5%) were managed in home isolation setting, 17 patients (39.5%) needed admission to ward, 4 patients (9%) in intermediate care unit and 2 patients (4%) admitted to intensive care unit. About 60% of cases were on room air, only 3 patients needed invasive methods, 2 patients needed face mask and 1 case needed invasive CPAP. In total, 41 patients recovered (95%) and 2 patients (5%) died; 1 was Covid related and the other one was non-Covid related. Female gender, higher BMI and hypertension were associated with severe course of the disease. CONCLUSION: In the setting of LDLT, the possibilities of catching Covid-19 infection are high due to chronic immunosuppression use. Yet, the outcome of infection in term of morbidity and the needs for hospital admission or intensive care is generally matched to general population.

Optimizing outcome of recurrent hepatitis C virus genotype 4 after living donor liver transplantation: moving forward by looking back.

PURPOSE: Recurrence of HCV after LDLT is almost universal. Different factors affect response to treatment. Few data are available regarding outcome of recurrent HCV genotype 4. The purpose of this study is to improve outcome of recurrent HCV genotype 4 after LDLT. METHODS: An IRB approved chart review of 243 patients transplanted for ESLD, HCV genotype 4 over 4 years were reviewed. Protocol liver biopsies were taken 6 months after transplant. Patients received pegylated interferon and ribavirin in case of histological recurrence. Five patients had FCH were excluded. RESULTS: Thirty-seven patients were included. Sustained Virological Response (SVR) was achieved in 29 (78.3%). Patients with Metavir fibrosis stage (F0) and (F1) had SVR in 5/5 (100%) and 20/24 (83.3%). Two patients with F1 had to stop treatment because of thrombocytopenia and 2 were non responders. Three out of 6 patients (50%) with (F2) had SVR, 2 were non responders and one had to discontinue treatment because of severe depression. One of 2 patients (50%) with F3 had SVR and the other patient decompensated within 4 months before treatment and died. CONCLUSION: Protocol biopsies allow early detection of inflammatory changes in the graft before fibrosis occurs. Early treatment of recurrent HCV genotype 4 after LDLT results in better response.

The use of terlipressin for management of dynamic left ventricular outflow tract obstruction complicating orthotropic liver transplantation: a case report.

We describe a patient with structurally normal heart who developed hemodynamic instability during orthotropic liver transplantation caused by severe dynamic left ventricular outflow tract obstruction. Successful management of this adverse event was facilitated by the use of intravenous terlipressin. The case highlights a role for terlipressin as a selective vasopressin receptor agonist with subsequent effects on systemic vascular resistance.

Anatomy of the right liver lobe: a surgical analysis in 124 consecutive living donors.

BACKGROUND: Understanding anatomic variations of the right lobe is fundamental in adult to adult living donor liver transplantation. METHODS: We analysed anatomy in 124 right liver (RL) donors. RESULTS: Portal vein: normal anatomy was found in 85.5% donors. In 14.5% the main right portal vein (PV) was absent. Hepatic artery: single arterial inflow of the RL was identified in 96% of donors. In 4% two arterial stumps were found. Bile duct: classic anatomy was identified in 50.8% of donors; 9.7% had a trifurcation of the common bile duct; in 7.2% the right anterior and in 15.3% the right posterior bile duct opened into the left bile duct; one segmental bile duct opened directly into the common bile duct in 12.1% and two segmental bile ducts in 4.8%. Hepatic veins (HV): in 74.3% the right HV was the single outflow; in 24.2% significant accessory HV (>5 mm) were preserved, in 2.4% the middle HV was harvested. We found that patients with PV variations had high incidence of multiple bile ducts (88.9%) while patients with single right PV had lower incidence (42.4%) (p = 0.00026). CONCLUSION: While anatomic variations in the RL donor were common, no contraindication to RL harvesting was noted in this study.