Liver Transplant Imaging prior to and during the COVID-19 Pandemic

Abstract

Background. The suspension of the surgical activity, the burden of the infection in immunosuppressed patients, and the comorbidities underlying end-stage organ disease have impacted transplant programs significantly, even life-saving procedures, such as liver transplantation. Methods. A review of the literature was conducted to explore the challenges faced by transplant programs and the adopted strategies to overcome them, with a focus on indications for imaging in liver transplant candidates. Results. Liver transplantation relies on an appropriate imaging method for its success. During the Coronavirus Disease 2019 (COVID-19) pandemic, chest CT showed an additional value to detect early signs of SARS-CoV-2 infection and other screening modalities are less accurate than radiology. Conclusion. There is an emerging recognition of the chest CT value to recommend its use and help COVID-19 detection in patients. This examination appears highly sensitive for liver transplant candidates and recipients, who otherwise would have not undergone it, particularly when asymptomatic.

Screening, Surveillance, and Management of Hepatocellular Carcinoma During the COVID-19 Pandemic: a Narrative Review

“…Patients with poor short-term prognosis, like high MELD score and HCC at the upper limits of the Milan, should be prioritized and delay is not recommended [ 15 , 19 , 22 , 35 , 48 – 51 ]. Elective living donor liver transplantation was suspended in some centers because of the risk of COVID-19 infection to the healthy donor while on admission [ 40 , 52 , 53 ]. Therefore, while transplant is still a consideration, other alternative management for early disease and bridging treatment should be prioritized to delay disease progression during the organ shortage.…”

Pediatric Liver Transplantation: Long-Term Follow-Up Issues

“…In contrast to early HAT (which has a higher incidence in lower volume centers), late HAT is uncommon and could in fact represent a late detection of a progressive early HAT; it is eventually detected with ultrasonographic monitoring or by the deterioration of the patient's general health status. 11 At this stage, liver function remains mostly stable, given the presence of extensive collateralization, although occasionally transaminases could unexpectedly raise. Concomitant biliary complications, especially in the presence of the "parvus tardus" sign, could be diagnostic for late HAT.…”