A case of COVID-19 1 month after ABO-incompatible living donor liver transplantation

Abstract

COVID-19 due to SARS-CoV-2 spread from China in December 2019 and is still a worldwide problem in August 2022. The seventh wave of the epidemic has arrived in Japan, and the number of infected patients is increasing. We report here our experience with a case of COVID-19 1 month after living donor liver transplantation. A 69-year-old female with decompensated cirrhosis due to nonalcoholic steatohepatitis underwent living donor liver transplantation. The donor was her 43-year-old daughter, and the graft was from the right lobe of the liver. The patient had postoperative bile leak and underwent reoperation on postoperative day 4, but otherwise, the postoperative course was generally good. The recipient's blood type was B Rh+ and the donor's blood type was A Rh+. The patient was immunosuppressed with FK, MMF, and steroids after surgery. On postoperative day 32, the patient developed a sore throat, hoarseness, and low-grade fever. PCR test was positive for SARS-CoV-2, and the patient was diagnosed with COVID-19. Respiratory failure was not observed, and the patient was considered mild illness. Remdesivir 200 mg/ day was administered for 3 days, and the dose of MMF was reduced to half. FK and steroids were continued at the same dose, however, FK was measured daily at trough level. Symptoms disappeared 3 days after the onset of the disease, and the trough level of FK passed without significant change. With the spread of COVID-19 infection, the number of cases of COVID-19 after transplantation is likely to increase, and accumulation and analysis of medical data is desirable.