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Liver transplant recipients infected with SARS‐CoV‐2 in the early postoperative period: Lessons from a single center in the epicenter of the pandemic
Authors:Daniel Reis Waisberg  Edson Abdala  Lucas Souto Nacif  Luciana Bertocco Haddad  Liliana Ducatti  Vinicius Rocha Santos  Larissa Nunes Gouveia  Carolina Santos Lazari  Rodrigo Bronze Martino  Rafael Soares Pinheiro  Rubens Macedo Arantes  Debora Raquel Terrabuio  Luiz Marcelo Malbouisson  Flavio Henrique Galvao  Wellington Andraus  Luiz Augusto Carneiro‐D'Albuquerque
Abstract:
The impact of coronavirus disease‐19 (COVID‐19) in liver recipients remains largely unknown. Most data derive from small retrospective series of patients transplanted years ago. We aimed to report a single‐center case series of five consecutive patients in the early postoperative period of deceased‐donor liver transplantation who developed nosocomial COVID‐19. Two patients presented important respiratory discomfort and eventually died. One was 69 years old and had severe coronary disease. She rapidly worsened after COVID‐19 diagnosis on 9th postoperative day. The other was 67 years old with non‐alcoholic steatohepatitis, who experienced prolonged postoperative course, complicated with cytomegalovirus infection and kidney failure. He was diagnosed on 36th postoperative day and remained on mechanical ventilation for 20 days, ultimately succumbing of secondary bacterial infection. The third, fourth, and fifth patients were diagnosed on 10th, 11th, and 18th postoperative day, respectively, and presented satisfactory clinical evolution. These last two patients were severely immunosuppressed, since one underwent steroid bolus for acute cellular rejection and another also used anti‐thymocyte globulin for treating steroid‐resistant rejection. Our novel experience highlights that COVID‐19 may negatively impact the postoperative course, especially in elder and obese patients with comorbidities, and draws attention to COVID‐19 nosocomial spread in the early postoperative period.
Keywords:COVID‐19  liver transplantation  postoperative period  severe acute respiratory syndrome coronavirus 2
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