A case of an Infant with SARS‐CoV‐2 hepatitis early after liver transplantation

Abstract

Rapidly evolving literature describes case reports of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the myriad of clinical manifestations of this infection known as coronavirus disease 2019. 1 Few studies have clinically characterized the disease in the pediatric population 2 and none in immunosuppressed children. At least one clinical report suggests that immunosuppressed patients are not at increased risk for severe disease or mortality. 3 In this report, we describe the clinical course and treatment of a 6-month-old female who underwent living related donor liver transplant (LT) from her mother and tested positive for SARS-CoV-2 four days post-operatively. In the interest of rapidly circulating information to our community, we previously published a partial description of this case focused on histopathology. 4 For the benefit of a wider pediatric transplant audience, we hope to provide more detailed information regarding the clinical course as it relates to available treatment and immunosuppression management.

Hepatic pathology in patients dying of COVID-19: a series of 40 cases including clinical, histologic, and virologic data

“…It will be interesting to investigate this variable in a larger number of cases. We have previously reported moderate acute hepatitis in a liver allograft recipient (distinct from the allograft recipient in this report) whose biopsy demonstrated large clusters of apoptotic hepatocytes with abundant lymphohistiocytic inflammation [5,6]. None of the cases in this series were as profoundly affected as that case.…”

“…A more recent study performed core needle biopsies on the livers of four patients and reported nonspecific findings, attributed to preexisting disease or perimortem injury [4]. Our group recently described moderate acute hepatitis in a liver allograft recipient with concomitant acute cellular rejection [5,6]. Nonetheless, the spectrum of histological liver injury in COVID-19 remains unknown.…”

Unique challenges in pediatric anesthesia created by COVID-19

“…Thus, we conducted a comprehensive literature search through MED-LINE on July 7th, 2020, containing sets of terms reflecting our topic of interest including the disease (COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)), perioperative period, and pediatric patients, which yielded 152 abstracts (Supplementary online resource 1). Out of these abstracts, we identified 7 case reports/series [4][5][6][7][8][9][10] and 1 retrospective cohort study [11]. Table 1 summarizes a total of 20 pediatric patients with diagnosed COVID-19 who underwent general anesthesia.…”

“…Out of 20 patients, 12 required emergent surgeries and 9 patients had preoperative symptoms such as cough, fever, rhinorrhea, or diarrhea. Three patients who required noninvasive ventilation postoperatively did not have any preoperative symptoms, and were subsequently diagnosed with COVID-19 [4,7,8]. One patient mortality occurred, as a result of small bowel necrosis secondary to intussusception, and concurrent acute respiratory failure due to COVID-19 pneumonia [6].…”

Enabling liver transplantation during the COVID-19 era: More than screening donors and recipients for SARS-CoV-2

“…In conclusion, even though SARS-CoV-2 infection in the early postoperative period after LT has been reported by some centers (1,(5)(6)(7)(8), those that adopted multimodal strategies were able to successfully prevent such infections (2,3). By adopting more extensive in-hospital measures and by establishing tailored discharge plans, we reduced our infection rate from 42.85% to 7.14%, despite an increase in the number of new cases in the city.…”