Impact and management of COVID-19 in liver transplant candidates and recipients

Abstract

The COVID-19 outbreak has had severe consequences for global public health, medical communities, and the socioeconomic status of a considerable number of countries. The emergence of COVID-19 has also significantly impacted the world of liver transplantation (LT). Studies from transplantation centers around the world have shown that LTs during the COVID-19 pandemic have been restricted because of the high risk of serious COVID-19 infection in this population. According to the Centers for Disease Control and Prevention, patients with liver disease are considered at higher risk for severe COVID-19 infection. In March 2020, the American Association for the Study of Liver Diseases recommended that LT should be limited to emergency cases. The COVID-19 treatment guidelines published by the National Institutes of Health are being constantly updated according to new epidemiology trends and treatment regimens. Immunocompromised patients have a higher risk of developing severe disease or death from COVID-19 compared with the general population. In this review, we summarize the available evidence regarding treatment guidelines and considerations for the evaluation and management of LT candidates and recipients in the era of COVID-19. In addition, we present data regarding COVID-19 among LT patients in our local transplantation center.

COVID‐19‐associated liver injury: Adding fuel to the flame

“…Probably, different mechanisms of immunosuppressive agents could explain for these results. 55,58 MMF has an inhibitory effect on activated lymphocytes, which is similar to the direct toxicity of SARS-CoV-2 on CD8 + T cells, implying that they have a synergistic effect on lymphocytes. In addition to regulating memory T cell activity, mTOR inhibitors, for example, everolimus, can reduce the replication of many viruses.…”

“…54 According to a report, the prevalence of COVID-19 among LT candidates is 6.05%, which is twice that of the general population. 55 Although some studies hold the opinion that the severity of COVID-19 in LT patients is similar to or even lower than that of the general population, serum ALP levels and lymphovascular infiltration among HCC patients produced significant differences between the prepandemic and pandemic periods in a research of United States, which means worse prognosis after LT. 56,57 More research illustrated that the different course of COVID-19 among LT patients may be related to the patient age, gender, • Diarrhea, nausea, and dizziness [41] Chloroquine or hydroxychloroquine and/or azithromycin Antimalarial drug; heme polymerase inhibitor • Aggravate the existing liver injury; accumulate in the liver [36,42] • Elevated ALT, AST level, or bilirubin level Interferons A family of cytokines • Nausea, fatigue, elevated transaminases [41,43] • Autoimmune hepatitis Ivermectin An antiparasitic drug • Dizziness, nausea, or diarrhea [41,44,45] • Elevation of liver enzymes…”