Clinical Practice Issues for Liver Transplantation in COVID-19 Recovered Recipients

Abstract

The ongoing burden of COVID-19 in persons with end stage liver failure necessitates the development of sound and rational policies for organ transplantation in this population. Following our initial experience with two COVID-19 recovered recipients who died shortly after transplant, we adjusted our center policies, re-evaluated outcomes, and retrospectively analyzed the clinical course of the subsequent seven COVID-19 recovered recipients. There were two early deaths and 5 successful outcomes. Both deceased patients shared common characteristics in that they had positive SARS-CoV2 PCR tests proximal to transplant (7-17 days), had acute on chronic liver failure, and suffered thromboembolic phenomena. After a careful review of clinical and virological outcome predictors, we instituted policy changes to avoid transplantation in these circumstances. We believe that our series offers useful insights into the unique challenges that confront transplant centers in the COVID-19 era and could guide future discussions regarding this important area.

Organ Recovery and Non-Lung Organ Transplantation in Candidates Recovering from COVID-2019

“…4 The recent report by Shetty et al published in Progress in Transplantation underscores the unique challenges and considerations of liver transplantation in COVID-19 recovering recipients. 5 The authors point to a plausible synergy between the prothrombotic proclivities of COVID-19 and acutely decompensating cirrhosis that may culminate in perioperative thromboembolic complications. Based on their experience with a small (7 recipients) case-series the authors believe thromboembolism to be the most significant deterrent to transplantation in convalescing recipients.…”

“…First, patient #1 had a positive PCR result 102 days and 7 days prior to surgery, with a negative result in between. 5 The Organ Procurement and Transplantation Network (OPTN) cautions that reinfections with SARS-CoV-2 may occur in immunocompetent individuals >90 days after initial infection. 6 Thus, the second positive result 7 days prior to transplantation in patient #1 with immune dysfunction of cirrhosis most likely reflects reinfection.…”