Since identified in December 2019, COVID-19 has remained a pandemic across the globe. Although primarily a respiratory illness, the impact of COVID-19 on other end organs has been increasingly identified. The effect of COVID-19 on the liver has yet to be completely understood. We describe a case of COVID-19 leading to end-stage cholangiopathy and deceased donor liver transplantation (LT). A 64-year-old man with no underlying respiratory or liver disease presented with acute respiratory distress secondary to COVID-19 pneumonia requiring intubation. Several months after resolution of his respiratory symptoms, he developed transaminitis, worsening jaundice, abdominal pain and dark-coloured urine. Hepatic function remained severely impaired warranting LT 259 days following his initial COVID-19 diagnosis. Explant pathology demonstrated diffuse hepatic injury, onion skinning of the bile ducts and bile duct loss in scattered portal tracts. As more patients develop COVID-19-related complications, we suggest LT as an option for COVID-19-related end-stage liver disease.

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Introduction Urinary diversion in pediatric renal transplant candidates with bladders not amenable to primary reconstruction can be achieved by pre‐transplant ileal conduit creation. We performed cutaneous ureterostomies to limit pre‐transplant surgery, protect the peritoneum for dialysis, transplant patients sooner, and preserve ureter length for future surgical reconstruction. Methods We compared four pediatric transplant recipients with ureterostomies to four recipients with ileal conduits from 2009 to 2017. Results All patients with ileal conduits developed at least one urinary tract infection (UTI) within 1 year of transplant and three of four patients had recurrent UTIs within the first year. Two patients required ileal conduit revisions for redundant conduits and recurrent UTIs. Of the four ureterostomy patients, two patients had UTIs within one year of transplant. Two patients developed ureterostomy strictures requiring revision at the fascial level; one was associated with a UTI. Conclusion In our small case series, ureterostomy allowed for a single operative intervention with preservation of ureter length for later reconstruction. Ureterostomy is safe and recurrent UTI may be lower in the ureterostomy group. Long‐term evaluation of ureterostomy for urinary diversion in pediatric kidney transplant is warranted.

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CHLT in adolescents and young adults is performed increasingly for failed palliation of single ventricle congenital heart disease. 1 Although longitudinal studies have reported equivalent post-transplant survival compared with HT alone, post-operative morbidity, including the prevalence of AKI and CKD, has yet to be characterized sufficiently. 2 Given the highly morbid nature of CHLT, this remains an important area of study. 1 Although studies in the CHLT population are rare, 1 isolated heart and liver transplants are independently associated with AKI and CKD development. 3 AKI occurs in up to 72% of pediatric HT

Introduction Transfusion protocols are not well‐studied for pediatric patients with acute liver failure (ALF). This study evaluates the utility of an international normalized ratio (INR)‐based transfusion threshold for these patients. Methods Forty‐four ALF pediatric patients from 2009 to 2018 were reviewed and divided into two groups: (a) a threshold group including patients between 2009 and 2015 who were transfused for an INR above 3.0, per institutional policy (n = 30), and (b) a post‐threshold group including patients after 2015 through 2018 who were transfused based on clinical judgment (n = 14). Preoperative INRs, preoperative transfusions, intraoperative transfusions, early reoperation, renal function, graft function and deaths were compared. Results Liver failure severity was similar between threshold and post‐threshold groups. Threshold patients had a lower average INR prior to transplantation, 2.8 (range 1.8‐3.8) vs 4.4 (range 2.1‐9.0), respectively (P = .01). Twenty‐six threshold patients (87%) received preoperative FFP compared with seven post‐threshold patients (50%, P = .0088). Two threshold patients (7%) received preoperative cryoprecipitate compared with five post‐threshold patients (36%, P = .014). The incidence of pre‐transplant bleeding, operative transfusions, and 1‐year patient and graft survival did not differ significantly. Conclusion Clinical judgment vs an INR‐based threshold for transfusions did not increase perioperative complications in children with ALF.