The Impact of COVID-19 Pandemic on Living Donor Liver Transplantation: An Integrated Mitigation Strategy with Successful Outcome

Abstract

With declaration of the pandemic, 339 patients were managed at a single LDLT center comprising the reported population. Of these, 315(93%) were pre-pandemic recipients and 24(7%) were active candidates. From the outset, integrated national, regional and hospital-based mitigation strategies were promptly defined and implemented. To measure the impact of the outbreak and adjust for non-COVID-19 covariates, a case-time-control group was identified. With 9-month follow-up, SARS-CoV-2 was diagnosed in 3(1%) pre-COVID-19 LDLT recipients and 2(8%) active-candidates with respective mortality of 33% and 100%. With 8(33%) total waiting-list mortalities, the remaining 16(67%) underwent urgent LDLT. Compared to the case-time-control group, the pandemic significantly (p<0.001) reduced transplant activity and increased (p=0.01) waiting-list mortality. With transplantation, none of the donors, recipients, or healthcare providers developed COVID-19. Preoperative screening detected SARS-CoV-2 in 1(6%) donor advancing to donation after negative RT-PCR. Transplantation achieved similar (p=0.38) 6-month survival among study (92%) and case-time-control (84%) recipients. Hospital stay was shorter (p=0.006) with fewer (p=0.11) readmissions and no primary infectious complications among study recipients. To our knowledge, this is the first study to prospectively assess COVID-19 impact on LDLT and describe measures allowing full return of transplant activities. With integrated COVID-19 mitigation strategies, LDLT is safe and achieves excellent outcome.