Successful orthotopic liver transplantation in a patient with a positive SARS-CoV2 test and acute liver failure secondary to acetaminophen overdose |
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Authors: | Carol Rouphael Giuseppe D’Amico Kristin Ricci Jacek Cywinski Cyndee Miranda Christine Koval Abhijit Duggal Cristiano Quintini K. V. Narayanan Menon Charles Miller Jamak Modaresi Esfeh |
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Affiliation: | 1. Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio;2. Transplantation Center, Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio;3. Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio;4. Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio;5. Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio;6. Department of Critical Care, Cleveland Clinic, Cleveland, Ohio |
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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. |
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Keywords: | clinical research/practice drug toxicity fulminant hepatic failure infection and infectious agents – viral infectious disease liver transplantation/hepatology plasmapheresis/plasma exchange |
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