Background

Maintaining standards of living donor liver transplantation (LDLT) can be a challenge during the corona virus disease 2019 (COVID-19) pandemic. Center-specific protocols have been developed and transplant societies propose limiting elective LDLT. We have looked at outcomes of LDLT during the pandemic in an exclusively LDLT center.

Methods

Patients were grouped into pre-COVID (January 2019-February 2020) (n = 162) and COVID (March 2020-January 2021) (n = 53) cohorts. We looked at patient characteristics, 30-day morbidity, and mortality. Outcomes were also assessed in donors and recipients who underwent surgery after recovery from COVID-19.

Results

The average number of transplants reduced from 11.5/month to 4.8/month. Fewer patients with MELD > 20 underwent LDLT in the COVID cohort (41.3% versus 24.5%, P = 0.03). Out of nine patients with a positive pretransplant COVID-19 PCR, there were 2 (22.3%) deaths on the waiting list. Seven patients underwent LT after recovery from COVID-19 with one 30-day mortality due to biliary sepsis. Three donors with positive COVID-19 PCR underwent uneventful donation after testing negative for COVID-19. No significant difference in 30-day survival was observed in the pre-COVID and COVID cohorts (93.2% versus 90.6%) (P = 0.3). Out of two recipients who developed COVID-19 pneumonia within 30 days after LT, there was one mortality. The 1-year survival for the entire cohort with a MELD cutoff of 20 was 90% and 84% (P = 0.2).

Conclusion

Despite comparable outcomes, fewer sick patients might undergo LDLT during the pandemic. Individuals recovered from COVID-19 might be safely considered for donation or transplantation.

中文翻译：

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COVID-19 大流行期间的活体肝移植：不断发展的挑战

背景

在 2019 年冠状病毒病 (COVID-19) 大流行期间，维持活体肝移植 (LDLT) 的标准可能是一项挑战。已经制定了特定于中心的协议，移植协会建议限制选择性 LDLT。我们在专门的 LDLT 中心研究了大流行期间 LDLT 的结果。

方法

患者被分为 COVID 前（2019 年 1 月至 2020 年 2 月）（n = 162）和 COVID（2020 年 3 月至 2021 年 1 月）（n = 53）组。我们研究了患者特征、30 天发病率和死亡率。还评估了从 COVID-19 康复后接受手术的捐赠者和接受者的结果。

结果

平均移植次数从每月 11.5 次减少到每月 4.8 次。在 COVID 队列中，MELD > 20 的患者较少接受 LDLT（41.3% 对 24.5%，P = 0.03）。在 9 名移植前 COVID-19 PCR 阳性的患者中，有 2 人（22.3%）在等待名单上死亡。7 名患者在从 COVID-19 康复后接受了 LT，其中 1 名患者因胆道败血症而在 30 天内死亡。三名 COVID-19 PCR 阳性的捐赠者在 COVID-19 检测呈阴性后顺利进行了捐赠。在 COVID 之前和 COVID 队列中未观察到 30 天生存率存在显着差异（93.2% 对 90.6%）（P = 0.3）。在 LT 后 30 天内发生 COVID-19 肺炎的两名接受者中，有一名死亡。MELD 截止值为 20 的整个队列的 1 年生存率为 90% 和 84% (P = 0.2)。

结论

尽管结果相似，但在大流行期间可能会接受 LDLT 的病人较少。从 COVID-19 中康复的个体可以安全地考虑进行捐赠或移植。