Coronavirus Disease 2019 in the Early Postoperative Period of Liver Transplantation: Is the Outcome Really So Positive?

Abstract

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

Outcomes of COVID-19 in hospitalized kidney and liver transplant recipients- a single-center experience

“…The data regarding the course of COVID-19 in the early post-transplant period is still limited and risks of perioperative in-hospital SARS-CoV-2 infection during the transplantation must be considered in recipient qualification [33]. In our study, three kidney and four liver transplant recipients were infected with SARS-CoV-2 in the perioperative period, of whom one patient with renal transplant died within 43 days after transplantation.…”

Outcomes of COVID-19 in Patients with Cirrhosis or Liver Transplantation

“…After excluding age, diabetes and chronic kidney disease significantly associated with mortality Polak 4 244 36 (14.7%) died, internet based survey Webb 34 39 Data from registry, 9 (23%) died, 4 of death happened in patients transplanted < 2 years back, 4 of died had diabetes and hypertension, 3 were obese Rabiee 35 112 25 (22.3%) died, LT recipients had lower acute liver injury when compared to age and sex matched CLD, reduction of immunosuppression was not associated with liver injury/mortality. ALI significantly associated with mortality Lee 36 38 7 died (18% overall, 29% of hospitalized) Dumortier 37 104 20 died, age independently associated with mortality Becchetti 38 57 7 died (12%), 5 of 7 mortalities happened in cases with history of cancers Colmenero 39 111 31.5% had severe disease, 20 (18%) mortality Webb 40 151 28 (19%) died, when compared to matched non-transplant population, mortality was not high in transplant recipients Dhampalwar 41 12 1 died Case reports or small series 32 , 42 , 43 , 44 , 45 , 46 27 9 died Total 1138 211 died (18.5%) …”

“…This series had several important differences from series by Massoumi et al The patients were older and had more comorbidities, and most of patients were diagnosed with COVID-19 at the index hospitalization. 46 …”

Liver transplant after SARS-CoV-2 infection: A systematic review

“…Despite being a small number, the authors identified 3 cases in which the recipient acquired SARS-CoV-2 infection shortly before the LT, and the authors found no significant difference in their initial presentation, clinical course, and outcome when compared to patients who had negative SARS-CoV-2 RT-PCR assay at the moment of LT.[ 12 , 21 , 22 ] On the other hand, the group has previously shown that COVID-19 diagnosis shortly after LT may be associated with worse outcomes, especially in older patients with comorbidities who acquired the infection during the posttransplant hospitalization period. [ 27 , 28 ] Therefore, multimodal strategies are necessary to prevent such infections during the COVID-19 era. [29] …”