Early liver transplantation after COVID-19 infection: The first report

Kulkarni, Anand V.; Parthasarathy, K; Kumar, Pramod; Sharma, Mithun; Reddy, Raghuram; Venkata, Krishna Chaitanya Akkaraju; Gupta, Rajesh; Gupta, Anand; Swaroop, Shakti; Vishwanathan, Premkumar Giri; Senapathy, Gayathri; Menon, P.B.; Reddy, Nageshwar; Padaki, Nagaraja Rao

doi:10.1111/ajt.16509

Cited by 48 publications

(43 citation statements)

References 18 publications

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“…This complication remains a rare complication and even fewer cases of transplantation after COVID-19 infection have been reported. 28 As more patients recover from COVID-19, it is possible that they will have other viral sequelae, or sequelae from medications administered during treatment, requiring further work-up as described here. It has been widely reported that patients with underlying liver disease represent a higher risk of severe COVID-19 illness.…”

Section: Discussionmentioning

confidence: 99%

Liver transplantation for post-COVID-19 sclerosing cholangitis

et al. 2021

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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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Section: Discussionmentioning

confidence: 99%

Liver transplantation for post-COVID-19 sclerosing cholangitis

et al. 2021

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“…Further, SARS-CoV-2 can worsen liver disease, and LT cannot be delayed due to increased waitlist mortality risk [8,9]. Therefore, transplant centres have initiated SOTs globally [9,10]. Given that the effects of COVID-19 on liver graft injury in LT recipients are unclear, it is crucial to understand the clinical course, management, and outcomes of COVID-19 in these patients [11].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the presence of comorbidities and chronic immunosuppression may increase the risk of severe COVID-19 among SOT recipients [ 6 , 7 ]. Further, SARS-CoV-2 can worsen liver disease, and LT cannot be delayed due to increased waitlist mortality risk [ 8 , 9 ]. Therefore, transplant centres have initiated SOTs globally [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 on liver transplant recipients–A systematic review and meta-analysis

et al. 2021

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Background: Immunosuppression and comorbidities increase the risk of severe coronavirus disease-2019 in solid organ transplant (SOT) recipients. The outcomes of COVID-19 in liver transplant (LT) recipients remain unclear. We aimed to analyse the outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in LT recipients. Methods: The electronic databases were searched for articles published from 1 December 2019 to 20 May 2021 with MeSH terms COVID-19, SARS-CoV-2, and liver transplantation. Studies reporting outcomes in more than 10 LT recipients were included for analysis. LT vs non-LT patients with COVID-19 infection were compared for all-cause mortality, which was the primary outcome studied. We also evaluated the relation between the timing of COVID-19 infection post-LT (< one year vs > one year) and mortality. Findings: Eighteen articles reporting 1,522 COVID-19 infected LT recipients were included for the systematic review. The mean age (standard deviation [SD]) was 60¢38 (5¢24) years, and 68¢5% were men. The mean time (SD) to COVID-19 infection was 5¢72 (1¢75) years. Based on 17 studies (I 2 = 7¢34) among 1,481 LT recipients, the cumulative incidence of mortality was 17¢4% (95% confidence interval [CI], 15¢4À19¢6). Mortality was comparable between LT (n = 610) and non-LT (n = 239,704) patients, based on four studies (odds ratio [OR], 0¢8 [0¢6À1¢08]; P = 0¢14). Additionally, there was no significant difference in mortality between those infected within one year vs after one year of LT (OR, 1¢5 [0¢63À3¢56]; P = 0¢35). The cumulative incidence of graft dysfunction was 2¢3% (1¢3À4¢1). Nearly 23% (20¢71À25) of the LT patients developed severe COVID-19 infection. Before infection, 71% and 49% of patients were on tacrolimus and mycophenolate mofetil, respectively. Immunosuppression was modified in 55¢9% (38¢1À72¢2) patients after COVID-19 infection. Interpretation: LT and non-LT patients with COVID-19 have a similar risk of adverse outcomes.

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“…This is the first unique report of COVID-19 masquerading as an AIH flare from India. COVID-19 can lead to ACLF and is associated with poor outcomes 3 , 4 . The abnormalities in liver function tests in COVID-19 could be due to virus-related cytopathic effects or nonviral causes such as cytokine storm, hypoxia, and hepatotoxic medications 1 , 5 .…”

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confidence: 99%