key: cord-0950382-m4enem7m
authors: Huang, Jiao‐Feng; Zheng, Kenneth I.; George, Jacob; Gao, Hai‐Nv; Wei, Ru‐Nan; Yan, Hua‐Dong; Zheng, Ming‐Hua
title: Fatal outcome in a liver transplant recipient with COVID‐19
date: 2020-05-04
journal: Am J Transplant
DOI: 10.1111/ajt.15909
sha: b58a11af998ae15dee70d255d6ba1039b7097ac4
doc_id: 950382
cord_uid: m4enem7m

Liver injury is common in patients with COVID‐19, but little is known about its clinical presentation and severity in the context of liver transplant. We describe a case of COVID‐19 in a patient who underwent transplant 3 years ago for hepatocellular carcinoma. The patient came to clinic with symptoms of respiratory disease; pharyngeal swabs for severe acute respiratory syndrome coronavirus 2 were positive. His disease progressed rapidly from mild to critical illness and was complicated by several nosocomial infections and multiorgan failure. Despite multiple invasive procedures and rescue therapies, he died from the disease. The management of COVID‐19 in the posttransplant setting presents complex challenges, emphasizing the importance of strict prevention strategies.

Liver injury is common in patients with COVID-19, but little is known about its clinical presentation and severity in the context of liver transplant. We describe a case of COVID-19 in a patient who underwent transplant 3 years ago for hepatocellular carcinoma. The patient came to clinic with symptoms of respiratory disease; pharyngeal swabs for severe acute respiratory syndrome coronavirus 2 were positive. His disease progressed rapidly from mild to critical illness and was complicated by several nosocomial infections and multiorgan failure. Despite multiple invasive procedures and rescue therapies, he died from the disease. The management of COVID-19 in the posttransplant setting presents complex challenges, emphasizing the importance of strict prevention strategies.

clinical research/practice, immunosuppressant, immunosuppression/immune modulation, infection and infectious agents, infection and infectious agents -viral, liver transplantation/ hepatology

The World Health Organization has labeled the spread of coronavirus disease 2019 (COVID-19) as a pandemic, 1 and the death toll has already exceeded that of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome. 2 Liver injury is commonly seen in patients with COVID-19, 3 but little is known regarding its clinical presentation and severity in the context of transplant. We report the case of a liver transplant recipient with COVID-19.

The patient was a 59-year-old man who was admitted to the isolation ward (on February 1, 2020) after 3 days of fever, cough, chills, In a previously reported case of successfully recovery from COVID-19 in a 52-year-old recipient of a renal transplant 12 years earlier, the patient was treated with a regimen that included lowdose corticosteroids. 7 In contrast, our patient was in a state of chronic rejection. The patient developed multiple nosocomial infections despite changes in treatment. After a retrospective review of his disease course, we suggest that an earlier and more aggressive approach with antiviral and antibacterial drug treatment might have been warranted. The primary cause of this patient's death was multiple infections that led to septic shock, rather than COVID-19. 

Data sharing is not applicable to this article as no new data were created or analyzed in this study. 

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