Ann Hepatobiliary Pancreat Surg.  2020 Aug;24(3):314-318. 10.14701/ahbps.2020.24.3.314.

A case of COVID-19 immediately after liver transplantation: Not only bad news

Affiliations
  • 1Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Bilbao, Spain
  • 2Medicine Faculty, University of the Basque Country
  • 3Infectious Disease Unit, Cruces University Hospital, Bilbao, Spain
  • 4Hepatology Unit, Cruces University Hospital, Bilbao, Spain

Abstract

COVID-19, the illness caused by the SARS-CoV-2 virus originated in December 2019 in Wuhan, China and has caused more 3,3 million cases and more than 230,000 deaths throughout the world, with 25,000 of them only in Spain, where the first case was diagnosed on January 31st, 2020. As COVID-19 is a “new” disease, we still do not have data on prognosis or treatment in transplant patients or on how to manage immunosuppression in this complex scenario. We present a case of COVID-19 diagnosed during the early postoperative period in a recipient whose liver transplantation was performed on late March during the lockdown in Spain, with donor and recipient previously negative rRT-PCR to SARS-CoV-2. In the first post-operative week the patient suffered COVID-19 pneumonia that was treated with immunosuppression minimization, oral Hydroxycloroquine and Azithromycin with favorable outcome. The patient was discharged on POD 21 without complications. To date, few early post-liver transplantation SARS-CoV-2 infected recipients have been published, but only one was an early postoperative infection. In our case the outcome was favorable, even though it was an early post -liver transplantation COVID-19 in a frail patient.

Keyword

Coronavirus; SARS-CoV-2; COVID-19; Transplantation; Liver

Figure

  • Fig. 1 Chest radiography showing diffuse bilateral infiltrates.

  • Fig. 2 Case report evolution. PR-TAC, prolonged released tacrolimus; D, day; LT, liver transplantation; POD, postoperative day.


Reference

1. World Health Organization. 2020. Coronavirus disease (COVID-19) outbreak [Internet]. World Health Organization;Geneva: Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019. cited 2020 May 3.
2. Spanish Ministry of Health. 2020. COVID-19 disease [Internet]. Ministerio de Sanidad;Paseo del Prado: Available from: https://www.mscbs.gob.es/en/profesionales/saludPublica/ ccayes/alertasActual/nCov-China/documentos/Actualizacion_ 67_COVID-19.pdf. cited 2020 May 3.
3. Wu Z, McGoogan JM. 2020; Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 323:1239–1242. DOI: 10.1001/jama.2020.2648. PMID: 32091533.
4. Shelhamer JH, Toews GB, Masur H, Suffredini AF, Pizzo PA, Walsh TJ, et al. 1992; NIH conference. Respiratory disease in the immunosuppressed patient. Ann Intern Med. 117:415–431. DOI: 10.7326/0003-4819-117-5-415. PMID: 1503334.
5. Michaels MG, La Hoz RM, Danziger-Isakov L, Blumberg EA, Kumar D, Green M, et al. 2020; Coronavirus disease 2019: implications of emerging infections for transplantation. Am J Transplant. 20:1768–1772. DOI: 10.1111/ajt.15832. PMID: 32090448.
Article
6. D'Antiga L. 2020; Coronaviruses and immunosuppressed patients: the facts during the third epidemic. Liver Transpl. 26:832–834. DOI: 10.1002/lt.25756. PMID: 32196933.
7. Pereira MR, Mohan S, Cohen DJ, Husain SA, Dube GK, Ratner LE, et al. 2020; COVID-19 in solid organ transplant recipients: Initial report from the US epicenter. Am J Transplant. 20:1800–1808. DOI: 10.1111/ajt.15941. PMID: 32330343. PMCID: PMC7264777.
Article
8. Lei S, Jiang F, Su W, Chen C, Chen J, Mei W, et al. 2020; Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. Version 2. EClinicalMedicine. doi: 10.1016/j.eclinm.2020.100331. [in press]. DOI: 10.1016/j.eclinm.2020.100331. PMID: 32292899. PMCID: PMC7128617.
9. Qin J, Wang H, Qin X, Zhang P, Zhu L, Cai J, et al. 2020; Perioperative presentation of COVID-19 disease in a liver transplant recipient. Hepatology. doi: 10.1002/hep.31257. [in press]. DOI: 10.1002/hep.31257. PMID: 32220017.
10. National Transplant Organization. 2020. Spanish recommendations to manage organ donation and transplantation regarding the infection associated with the new coronavirus (SARS-CoV-2) producer of COVID-19 [Internet]. Ministerio de Sanidad;Paseo del Prado: Available from: http://www.ont.es/infesp/RecomendacionesParaProfesionales/Spanish%20Recom mendations%20on%20Organ%20Donation%20and%20Transplan tation%20COVID-19%20%20ONT.pdf. cited 2020 Apr 16.
11. Gastaca M, Prieto M, Palomares I, Bustamante J, Fernandez JR, Ruiz P, et al. 2020; Long-term outcomes of liver transplantation in patients with pretransplant renal dysfunction treated with induction therapy and delayed reduced de novo once-daily tacrolimus. Transplant Proc. 52:1489–1492. DOI: 10.1016/j.transproceed.2020.01.083. PMID: 32217015.
Article
12. Osakidetza. 2020. Basque Health Department [Internet]. Departamento de Salud;San Juan: Available from: http://www.euskadi.eus/contenidos/informacion/boletin_coronavirus/es_def/adjuntos/30_marzo_Boletin.pdf. cited 2020 Mar 30.
13. Spanish Society of Liver Transplant. Recommendations of the SSLT against COVID-19 in liver transplantation [Internet]. Available from: https://www.sethepatico.org/docs/2020/Reco mend_IMS_COVID_TH.pdf. cited 2020 Apr 13.
14. AlGhamdi M, Mushtaq F, Awn N, Shalhoub S. 2015; MERS CoV infection in two renal transplant recipients: case report. Am J Transplant. 15:1101–1104. DOI: 10.1111/ajt.13085. PMID: 25716741. PMCID: PMC7159767.
Article
15. Li F, Cai J, Dong N. 2020; First cases of COVID-19 in heart transplantation from China. J Heart Lung Transplant. 39:496–497. DOI: 10.1016/j.healun.2020.03.006. PMID: 32362394. PMCID: PMC7156127.
Article
16. Liu B, Wang Y, Zhao Y, Shi H, Zeng F, Chen Z. 2020; Successful treatment of severe COVID-19 pneumonia in a liver transplant recipient. Am J Transplant. 20:1891–1895. DOI: 10.1111/ajt.15901. PMID: 32243673.
Article
17. Huang JF, Zheng KI, George J, Gao HN, Wei RN, Yan HD, et al. 2020; Fatal outcome in a liver transplant recipient with COVID-19. Am J Transplant. 20:1907–1910. DOI: 10.1111/ajt.15909. PMID: 32277591. PMCID: PMC7262021.
Article
18. Bhoori S, Rossi RE, Citterio D, Mazzaferro V. 2020; COVID-19 in long-term liver transplant patients: preliminary experience from an Italian transplant centre in Lombardy. Lancet Gastroenterol Hepatol. 5:532–533. DOI: 10.1016/S2468-1253(20)30116-3. PMID: 32278366. PMCID: PMC7146678.
Article
19. Webb GJ, Moon AM, Barnes E, Barritt AS, Marjot T. 2020; Determining risk factors for mortality in liver transplant patients with COVID-19. Lancet Gastroenterol Hepatol. 5:643–644. DOI: 10.1016/S2468-1253(20)30125-4. PMID: 32339474. PMCID: PMC7182520.
Article
20. Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. 2020; Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology. 296:E115–E117. DOI: 10.1148/radiol.2020200432. PMID: 32073353. PMCID: PMC7233365.
21. Siddiqi HK, Mehra MR. 2020; COVID-19 illness in native and immunosuppressed states: a clinical-therapeutic staging proposal. J Heart Lung Transplant. 39:405–407. DOI: 10.1016/j.healun.2020.03.012. PMID: 32362390. PMCID: PMC7118652.
Article
22. Costanzo M, De Giglio MAR, Roviello GN. 2020; SARS-CoV-2: recent reports on antiviral therapies based on lopinavir/ritonavir, darunavir/umifenovir, hydroxychloroquine, remdesivir, Favipiravir and other drugs for the treatment of the new coronavirus. Curr Med Chem. 27:4536–4541. DOI: 10.2174/0929867327666200416131117. PMID: 32297571.
Article
23. Kumar D, Manuel O, Natori Y, Egawa H, Grossi P, Han SH, et al. 2020; COVID-19: a global transplant perspective on successfully navigating a pandemic. Am J Transplant. 20:1773–1779. DOI: 10.1111/ajt.15876. PMID: 32202064. PMCID: PMC7228301.
Article
Full Text Links
  • AHBPS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr