Impact of the COVID-19 pandemic on liver donation and transplantation: A review of the literature

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has upended healthcare systems worldwide and led to an inevitable decrease in liver transplantation (LT) activity. During the first pandemic wave, administrators and clinicians were obliged to make the difficult decision of whether to suspend or continue a life-saving procedure based on the scarce available evidence regarding the risk of transmission and mortality in immunosuppressed patients. Those centers where the activity continued or was heavily restricted were obliged to screen donors and recipients, design COVID-safe clinical pathways, and promote telehealth to prevent nosocomial transmission. Despite the ever-growing literature on COVID-19, the amount of high-quality literature on LT remains limited. This review will provide an updated view of the impact of the pandemic on LT programs worldwide. Donor and recipient screening, strategies for waitlist prioritization, and posttransplant risk of infection and mortality are discussed. Moreover, a particular focus is given to the possibility of donor-to-recipient transmission and immunosuppression management in COVID-positive recipients.

COVID‐19 and the Liver: Lessons Learnt from the EAST and the WEST, A Year Later

“…In contrast, the impact of the second wave in India was notably different and likely to have had a severe effect on transplantation services 94,95 . Thus, there has been a significant heterogeneity in transplant activity among the various regions of the World 96 …”

“…94,95 Thus, there has been a significant heterogeneity in transplant activity among the various regions of the World. 96…”

Impact of the COVID-19 pandemic on the care and outcomes of people with NAFLD-related cirrhosis

“…Mortality has been proved to increase in patients with alcohol-associated liver disease, [ 19 ] and there have also been several reports on the impact of the COVID-19 pandemic on the diagnosis and management of hepatocellular carcinoma (HCC), [ 20 , 21 , 22 ] cirrhosis, [ 23 , 24 , 25 , 26 ] and liver transplant. [ 27 ]…”

“…Mortality has been proved to increase in patients with alcoholassociated liver disease, 19 and there have also been several reports on the impact of the COVID-19 pandemic on the diagnosis and management of hepatocellular carcinoma (HCC), [20][21][22] cirrhosis, [23][24][25][26] and liver transplant. 27 However, the impact of the pandemic on patients with cirrhosis due to NAFLD is poorly known. Therefore, this study aims to evaluate how COVID-19 effect on health systems during the first of the pandemic impacted outcomes of patients with NAFLD cirrhosis.…”

Centralization of Major Trauma Influences Liver Availability for Transplantation in Northern Italy: Lesson Learned from COVID-19 Pandemic

“…With regards to liver transplantation, it was evident that transplant teams faced significant difficulties in allocating a life-saving procedure during the pandemic. Literature on liver transplantation during COVID-19 pandemic is scarce, with unclear data collected in burdensome conditions [8]. Liver procurement from trauma patients has also suffered the consequences of the pandemic.…”