Successful pediatric liver transplantation case with a positive SARS‐CoV‐2 test at the time of transplant

Abstract

Aim We report a successful liver transplantation (LT) in a child with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Case Presentation A 3‐year‐old female patient with decompensated cirrhosis due to Alagille syndrome underwent a split LT with a left lateral segment graft. She had a history of SARS‐CoV‐2 infection 4 months before LT. She was exposed to SARS‐CoV‐2 after the decision for organ acceptance. We repeatedly confirmed the negative SARS‐CoV‐2 test by polymerase chain reaction (PCR) before LT. Liver transplantation was carried out in the negative pressure operational theater with full airborne, droplet, and contact precautions as the patient was considered to be within the incubation period of SARS‐CoV‐2. The SARS‐CoV‐2 PCR test became positive in the nasopharyngeal swab specimen at the operation. Remdesivir, the antiviral treatment, was held off due to potential hepatotoxicity and no exacerbation of COVID‐19. She received tacrolimus and low‐dose steroids per protocol. She remained SARS‐CoV‐2 positive on postoperative days (PODs) 1, 2, and 5. The presence of antibodies for SARS‐CoV‐2 at LT was confirmed later. On POD 53, she was discharged without any symptomatic infection. Conclusion This case demonstrated that a positive SARS‐CoV‐2 result was not an absolute contraindication for a life‐saving LT. Liver transplantation could be safely performed in a pediatric patient with asymptomatic COVID‐19 and S‐immunoglobulin G antibodies for SARS‐CoV‐2.