Impact of COVID-19 Infection on Liver Transplant Recipients: Does It Make Any Difference?

Punga, Daniela; Isac, Sebastian; Paraipan, Cristian; Cotorogea, Mihail; Stefan, Andreea Maria; Cobilinschi, Cristian; Văcăroiu, Ileana Adela; Tulin, Raluca; Ionescu, Dorin; Droc, Gabriela

doi:10.7759/cureus.22687

Cited by 3 publications

(5 citation statements)

References 28 publications

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“…The outcome of SARS-CoV-2-infected patients after liver transplantation could depend also on the infection time point, considering that immunosuppression intensity is also time-dependent and related to the drugs used [ 15 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

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Orthotopic Liver Transplantation of a SARS-CoV-2 Negative Recipient from a Positive Donor: The Border between Uncertainty and Necessity in a Pandemic Era- Case Report and Overview of the Literature

et al. 2023

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(1) Introduction: Liver transplantation represents the gold-standard therapy in eligible patients with acute liver failure or end-stage liver disease. The COVID-19 pandemic dramatically affected the transplantation landscape by reducing patients’ addressability to specialized healthcare facilities. Since evidence-based acceptance guidelines for non-lung solid organ transplantation from SARS-CoV-2 positive donors are lacking, and the risk of bloodstream-related transmission of the disease is debatable, liver transplantation from SARS-CoV-2 positive donors could be lifesaving, even if long-term interactions are unpredictable. The aim of this case report is to highlight the relevance of performing liver transplantation from SARS-CoV-2 positive donors to negative recipients by emphasizing the perioperative care and short-term outcome. (2) Case presentation: A 20-year-old female patient underwent orthotropic liver transplantation for Child-Pugh C liver cirrhosis secondary to overlap syndrome, from a SARS-CoV-2 positive brain death donor. The patient was not infected nor vaccinated against SARS-CoV-2, and the titer of neutralizing antibodies against the spike protein was negative. The liver transplantation was performed with no significant complications. As immunosuppression therapy, the patient received 20 mg basiliximab (Novartis Farmacéutica S.A., Barcelona, Spain) and 500 mg methylprednisolone (Pfizer Manufacturing Belgium N.V, Puurs, Belgium) intraoperatively. Considering the risk of non-aerogene-related SARS-CoV-2 reactivation syndrome, the patient received remdesivir 200 mg (Gilead Sciences Ireland UC, Carrigtohill County Cork, Ireland) in the neo-hepatic stage, which was continued with 100 mg/day for 5 days. The postoperative immunosuppression therapy consisted of tacrolimus (Astellas Ireland Co., Ltd., Killorglin, County Kerry, Ireland) and mycophenolate mofetil (Roche România S.R.L, Bucharest, Romania) according to the local protocol. Despite the persistent negative PCR results for SARS-CoV-2 in the upper airway tract, the blood titer of neutralizing antibodies turned out positive on postoperative day 7. The patient had a favorable outcome, and she was discharged from the ICU facility seven days later. (3) Conclusions: We illustrated a case of liver transplantation of a SARS-CoV-2 negative recipient, whose donor was SARS-CoV-2 positive, performed in a tertiary, university-affiliated national center of liver surgery, with a good outcome, in order to raise the medical community awareness on the acceptance limits in the case of COVID-19 incompatibility for non-lung solid organs transplantation procedures.

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Section: Discussionmentioning

confidence: 99%

“…The data from the literature revealed, however, conflicting results [ 13 , 14 ]. We have also previously shown that patients infected with SARS-CoV-2 following the liver transplantation surgery had good outcomes, and the survival rate was the same as for those without COVID-19 [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Orthotopic Liver Transplantation of a SARS-CoV-2 Negative Recipient from a Positive Donor: The Border between Uncertainty and Necessity in a Pandemic Era- Case Report and Overview of the Literature

et al. 2023

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“…Some data suggest that patients infected soon after transplant have no increased mortality risk, and in general immunosuppressed patients may not have higher mortality from COVID-19. 48 Tacrolimus has been associated with better survival, perhaps due to T-cell inhibition or direct antiviral effect. 48 Mycophenolate mofetil, on the other hand, is an independent predictor of severe COVID-19 in liver transplant recipients.…”

Section: Liver Transplantation and Covid-19mentioning

confidence: 99%

“… 48 Tacrolimus has been associated with better survival, perhaps due to T-cell inhibition or direct antiviral effect. 48 Mycophenolate mofetil, on the other hand, is an independent predictor of severe COVID-19 in liver transplant recipients. 47 As such, optimal management regarding immunosuppression in the setting of COVID-19 is unclear.…”

Section: Liver Transplantation and Covid-19mentioning

confidence: 99%

COVID-19-Associated Liver Injury

Gildea¹,

Woo²,

O'Connor³

et al. 2023

HMER

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This review analyzes data regarding liver injury associated with COVID-19 infection. We discuss reported effects on the liver from both COVID-19 and COVID-19 treatment as well as pathophysiology, review the potential role of drug-induced liver injury as an etiology of COVID-19-associated liver injury, and touch on other reports of significant outcomes including COVID-19 cholangiopathy and autoimmune hepatitis. Finally, we review the implications of COVID-19 infection in liver transplant recipients.

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“…Considering the COVID-19 pandemic, special attention should be given to immunocompromised patients [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

The Cumulative Detrimental Effect of COVID-19 Pneumonia in a Patient with Myasthenic Crisis: A Case Report and Overview of the Literature

Buzatu

Bobircă

Isac

et al. 2022

Life

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Background: As the COVID-19 pandemic reached its peak, it became unavoidable that patients with other risk factors for severe pulmonary impairment (such as neuromuscular illnesses) would become afflicted. While the subject of myasthenic crisis secondary to COVID-19 pneumonia represents an interesting topic in the literature, we could not find consistent data that include, as a novel therapeutic approach, both intravenous immunoglobulin and plasma exchange therapy for the treatment of these two concurrent diseases. Case summary: A 69-year-old man with known seropositive generalized myasthenia gravis, hypertension, ischaemic heart disease, NYHA class II-III heart failure, cerebrovascular disease, and recurrent urinary tract infections, was admitted to the ICU for mixed acute respiratory failure, elevated serum lactate and liver function enzymes, and severe thrombocytopenia. A SARS-CoV-2 PCR test was positive, despite a previous COVID-19 pneumonia episode, 10 months prior to the current one. The patient had a recent ICU admission for a myasthenic crisis, which required non-invasive mechanical ventilation and intravenous immunoglobulin therapy. He received supportive therapy, as well as etiological (intravenous remdesivir, plasmapheresis and intravenous dexamethasone). Fifteen days after admission, the patient was transferred to the neurological ward, whence he left 20 days later, with no apparent sequelae. Conclusions: Subsequent intravenous immunoglobulins and plasma exchange therapy appear to be effective and safe in patients with simultaneous acute myasthenic episode and COVID-19 pneumonia.

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Impact of COVID-19 Infection on Liver Transplant Recipients: Does It Make Any Difference?

Cited by 3 publications

References 28 publications

Orthotopic Liver Transplantation of a SARS-CoV-2 Negative Recipient from a Positive Donor: The Border between Uncertainty and Necessity in a Pandemic Era- Case Report and Overview of the Literature

Orthotopic Liver Transplantation of a SARS-CoV-2 Negative Recipient from a Positive Donor: The Border between Uncertainty and Necessity in a Pandemic Era- Case Report and Overview of the Literature

COVID-19-Associated Liver Injury

The Cumulative Detrimental Effect of COVID-19 Pneumonia in a Patient with Myasthenic Crisis: A Case Report and Overview of the Literature

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