Restarting LDLT During COVID-19: Early Results After Restructuring

Transplant Proc. 2021 May;53(4):1118-1125. doi: 10.1016/j.transproceed.2020.10.049. Epub 2020 Dec 16.

Abstract

Introduction: Living-donor liver transplantation (LDLT) has been mostly suspended and deceased-donor living transplantation activity has been considerably reduced because of coronavirus disease 2019 (COVID-19). We modified our protocols and procedures in line with COVID-19 guidelines. Since the restructuring, we have performed 20 LDLTs. Our study reports the outcomes of these cases and demonstrates the feasibility of LDLT during this pandemic.

Materials and methods: The changes were influenced by experiences and communications from across the globe. A month-long self-imposed moratorium was spent in restructuring the program and implementing new protocols. Twenty LDLTs were performed between April 18 and September 15 using the new protocols. Our experience includes 2 simultaneous liver-kidney transplants, 1 ABO-incompatible LDLT, and 1 pediatric case (age 11 months).

Results: Nineteen patients recovered and 1 patient died. We maintained our postoperative immunosuppression protocol without many changes. Major complications were observed in 30% of recipients but none of the donors. One recipient was infected with COVID-19 during the postoperative period. A donor-recipient couple contracted COVID-19 after discharge from the hospital. All patients recovered from COVID-19 and liver enzymes were unaffected.

Conclusion: This study represents a microcosm of experience in LDLT during the COVID-19 era. Outcomes of LDLT are not affected by COVID-19 per se, provided that we make necessary changes.

MeSH terms

  • ABO Blood-Group System
  • Adult
  • Blood Group Incompatibility
  • COVID-19 / immunology
  • COVID-19 / prevention & control*
  • COVID-19 / virology
  • Female
  • Humans
  • Immunosuppression Therapy / methods
  • Infant
  • Infection Control / methods*
  • Liver Transplantation / adverse effects
  • Liver Transplantation / methods*
  • Liver Transplantation / standards
  • Living Donors
  • Male
  • Middle Aged
  • Postoperative Complications / immunology
  • Postoperative Complications / prevention & control*
  • Postoperative Complications / virology
  • Postoperative Period
  • SARS-CoV-2*
  • Treatment Outcome

Substances

  • ABO Blood-Group System