key: cord-0807486-hcf4mlg3
authors: Buscemi, Vincenzo; De Carlis, Riccardo; Lauterio, Andrea; Merli, Marco; Puoti, Massimo; De Carlis, Luciano
title: Does interval time between liver transplant and COVID-19 infection make the difference?
date: 2020-08-25
journal: Dig Liver Dis
DOI: 10.1016/j.dld.2020.08.027
sha: 57cdb4a9c3b2ee4994e6ddbf53af62bc46ce561f
doc_id: 807486
cord_uid: hcf4mlg3

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Reports from literature refers to COVID-19 affected long-term liver recipients, with dissimilar treatment approaches varying from antiviral drugs (oseltamivir or lopinavir/ritonavir) to chloroquine/hydroxychloroquine and immunosuppression regimen minimization/maintenance with controversial and sometimes fatal outcomes, often reported in series including other organ recipients 2,3 .

As the liver transplant center of a major Italian hospital involved in the COVID-19 pandemic, we made every effort to protect our patients by providing screening with nasopharyngeal swab (NPS) and COVID-free areas. Nevertheless, a diabetic 61-years-old liver recipient affected by HCVrelated hepatocellular carcinoma and cirrhosis, after an initially uneventful postoperative course and a preoperative negative NPS for both donor and recipient, developed fever, dyspnea on the ninth postoperative day. We repeated two NPS that returned positive and chest X-ray that had demonstrated a right inferior lobe opacity. In absence of guidelines or previously reported cases of COVID-19 affected liver recipients on March 21 st , 2020 we decided to employ, after 3 days of persistent fever, 6 days of oral chloroquine 500 mg bis in die (BID) followed after fever remission and weaning from oxygen support (no CPAP was needed) by 6 more days of oral hydroxychloroquine 200mg BID, prescribing usual immunosuppression regimen with tacrolimus (blood level 7-8 ng/mL) and steroids and maintaining subcutaneous heparin at prophylactic doses.

Afterwards, following a progressive clinical resolution, the patient was discharged with two consecutive negative NPSs on post-transplant day 33. On the other hand, middle-long term transplant COVID-19 patients seem to show a high mortality rate probably caused by prolonged immunosuppression exposure and metabolic-related comorbidities and could require more aggressive treatments 3 .

Journal Pre-proof Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID position paper

Early Impact of COVID-19 on Transplant Center Practices and Policies in the United States

COVID-19 in solid organ transplant recipients: a single-center case series from Spain

Perioperative Presentation of COVID-19 Disease in a Liver Transplant Recipient

Clinical features of patients infected with 2019 novel coronavirus in Wuhan

Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): an atypical acute respiratory distress syndrome working hypothesis

The authors of this article have no conflict of interest or funding to disclose.