TY - JOUR
T1 - Liver transplantation for acute liver failure in a SARS-CoV-2 PCR-positive patient
AU - Yohanathan, Lavanya
AU - Campioli, Cristina C.
AU - Mousa, Omar Y.
AU - Watt, Kymberly
AU - Friedman, Daniel Z.P.
AU - Shah, Vijay
AU - Ramkissoon, Resham
AU - Hines, Alexander S.
AU - Kamath, Patrick S.
AU - Razonable, Raymund R.
AU - Badley, Andrew D.
AU - DeMartino, Erin S.
AU - Joyner, Michael J.
AU - Graham, Rondell
AU - Vergidis, Paschalis
AU - Simonetto, Doug A.
AU - Sanchez, William
AU - Taner, Timucin
AU - Heimbach, Julie K.
AU - Beam, Elena
AU - Leise, Michael D.
N1 - Publisher Copyright:
© 2021 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2021/8
Y1 - 2021/8
N2 - Current guidelines recommend deferring liver transplantation (LT) in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection until clinical improvement occurs and two PCR tests collected at least 24 hours apart are negative. We report a case of an 18-year-old, previously healthy African-American woman diagnosed with COVID-19, who presents with acute liver failure (ALF) requiring urgent LT in the context of SARS-CoV-2 polymerase chain reaction (PCR) positivity. The patient was thought to have acute Wilsonian crisis on the basis of hemolytic anemia, alkaline phosphatase:bilirubin ratio <4, AST:ALT ratio >2.2, elevated serum copper, and low uric acid, although an unusual presentation of COVID-19 causing ALF could not be excluded. After meeting criteria for status 1a listing, the patient underwent successful LT, despite ongoing SARS-CoV-2 PCR positivity. Remdesivir was given immediately posttransplant, and mycophenolate mofetil was withheld initially and the SARS-CoV-2 PCR test eventually became negative. Three months following transplantation, the patient has made a near-complete recovery. This case highlights that COVID-19 with SARS-CoV-2 PCR positivity may not be an absolute contraindication for transplantation in ALF. Criteria for patient selection and timing of LT amid the COVID-19 pandemic need to be validated in future studies.
AB - Current guidelines recommend deferring liver transplantation (LT) in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection until clinical improvement occurs and two PCR tests collected at least 24 hours apart are negative. We report a case of an 18-year-old, previously healthy African-American woman diagnosed with COVID-19, who presents with acute liver failure (ALF) requiring urgent LT in the context of SARS-CoV-2 polymerase chain reaction (PCR) positivity. The patient was thought to have acute Wilsonian crisis on the basis of hemolytic anemia, alkaline phosphatase:bilirubin ratio <4, AST:ALT ratio >2.2, elevated serum copper, and low uric acid, although an unusual presentation of COVID-19 causing ALF could not be excluded. After meeting criteria for status 1a listing, the patient underwent successful LT, despite ongoing SARS-CoV-2 PCR positivity. Remdesivir was given immediately posttransplant, and mycophenolate mofetil was withheld initially and the SARS-CoV-2 PCR test eventually became negative. Three months following transplantation, the patient has made a near-complete recovery. This case highlights that COVID-19 with SARS-CoV-2 PCR positivity may not be an absolute contraindication for transplantation in ALF. Criteria for patient selection and timing of LT amid the COVID-19 pandemic need to be validated in future studies.
KW - clinical research / practice
KW - immunosuppressive regimens - induction
KW - infection and infectious agents - viral
KW - liver disease: metabolic
KW - liver transplantation / hepatology
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U2 - 10.1111/ajt.16582
DO - 10.1111/ajt.16582
M3 - Article
C2 - 33792185
AN - SCOPUS:85105075251
SN - 1600-6135
VL - 21
SP - 2890
EP - 2894
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 8
ER -