Successful orthotopic liver transplantation in a patient with a positive SARS-CoV2 test and acute liver failure secondary to acetaminophen overdose

Abstract

SARS‐CoV2, first described in December 2019, was declared a pandemic by the World Health Organization in March 2020. Various surgical and medical societies promptly published guidelines, based on expert opinion, on managing patients with COVID‐19, with a consensus to postpone elective surgeries and procedures. We describe the case of an orthotopic liver transplantation (OLT) in a young female who presented with acute liver failure secondary to acetaminophen toxicity to manage abdominal pain and in the setting of a positive SARS‐CoV2 test. Despite a positive test, she had no respiratory symptoms at time of presentation. The positive test was thought to be residual viral load. The patient had a very favorable outcome, likely related to multiple factors including her young age, lack of respiratory COVID‐19 manifestations and plasma exchange peri‐operatively. We recommend a full work‐up for OLT in COVID‐19 patients with uncomplicated disease according to standard of care, with careful interpretation of COVID‐19 testing in patients presenting with conditions requiring urgent or emergent surgery as well as repeat testing even a few days after initial testing, as this could alter management.

Impact of COVID-19 in solid organ transplant recipients

“…Transplantation of infected candidates and utilization of organs from donors with COVID‐19 are currently only recommended after resolution of clinical symptoms and negative PCR testing. Initial reports of transplant recipients with resolved SARS‐CoV‐2 infection have shown favorable outcome 163 . Case reports of inadvertent transplantation of asymptomatic SARS‐CoV‐2 positive donors without transmission to the recipient 164 may indicate a potential use of PCR positive donors for life‐saving procedure, especially when more is known about the correlation between PCR positivity and infectivity 108‐110 .…”

The First Kidney Transplantation After Recipient and Living Donor Recovered From COVID-19

“…There are case reports in which it is pointed out that it can be conducted successfully. Ruophael et al [ 7 ] described successful orthotopic liver transplantation with a COVID-19 patient and Dhand et al [ 8 ] reported a successful liver transplantation in a patient who recovered from COVID-19.…”

2020 Clinical Update in Liver Transplantation

“…There have been multiple case reports of SARS-CoV-2 positive recipients receiving liver transplants after resolution of symptoms or negative tests with good outcomes. 16 , 17 , 18 , 19 …”

“…There have been multiple case reports of SARS-CoV-2 positive recipients receiving liver transplants after resolution of symptoms or negative tests with good outcomes. 16,17,18,19 A more comprehensive analysis was performed later in the pandemic to better understand the impact of COVID-19 on liver transplantation in the United States. 20 This study used the Scientific Registry of Transplant Recipients to compare waitlist registrations, waitlist mortality, and DDLTs from March to August of 2020 on expected values based on trends from January of 2016 to January of 2020.…”