The impact of coronavirus disease‐19 (COVID‐19) in liver recipients remains largely unknown. Most data derive from small retrospective series of patients transplanted years ago. We aimed to report a single‐center case series of five consecutive patients in the early postoperative period of deceased‐donor liver transplantation who developed nosocomial COVID‐19. Two patients presented important respiratory discomfort and eventually died. One was 69 years old and had severe coronary disease. She rapidly worsened after COVID‐19 diagnosis on 9th postoperative day. The other was 67 years old with non‐alcoholic steatohepatitis, who experienced prolonged postoperative course, complicated with cytomegalovirus infection and kidney failure. He was diagnosed on 36th postoperative day and remained on mechanical ventilation for 20 days, ultimately succumbing of secondary bacterial infection. The third, fourth, and fifth patients were diagnosed on 10th, 11th, and 18th postoperative day, respectively, and presented satisfactory clinical evolution. These last two patients were severely immunosuppressed, since one underwent steroid bolus for acute cellular rejection and another also used anti‐thymocyte globulin for treating steroid‐resistant rejection. Our novel experience highlights that COVID‐19 may negatively impact the postoperative course, especially in elder and obese patients with comorbidities, and draws attention to COVID‐19 nosocomial spread in the early postoperative period.

We read with interest the article by Massoumi et al. (1) regarding 5 patients who developed coronavirus disease 2019 (COVID-19) in the early postoperative period of liver transplantation (LT). None of them exhibited severe disease, and they all fully recovered, suggesting that COVID-19 in the early postoperative period of LT might not be associated with unfavorable outcomes. Here, we share our experience with 7 cases that was not so promising. Between March 24 and July 1, 2020, we performed 28 deceased donor LTs, and 7 patients were diagnosed with COVID-19 in the early posttransplant period, ranging from 9 to 39 days (Table 1). Because there is no clear definition for early COVID-19 after LT, we assumed it to be until postoperative day (POD) 60, irrespective of whether the patient had been discharged home or remained hospitalized.Unlike the series by Massoumi et al., (1) we experienced 3 cases of severe disease (patients 1, 2, and 7), with 2 deaths related to COVID-19. This difference

Despite the great number of cases of COVID‐19 around the world, data in liver transplant (LT) recipients are still settling down. We share our experience after the first four cases of long‐term LT recipients admitted for hospitalization and the measures for suspicion and diagnostic investigation adopted after these cases. The mean time of initial symptoms at hospitalization was 8 days; only one case had the classical respiratory symptoms.