key: cord-1010160-z0kd84gb
authors: Reiberger, Thomas; Mandorfer, Mattias
title: “Perioperative Presentation of COVID‐19 Disease in a Liver Transplant Recipient”
date: 2020-07-12
journal: Hepatology
DOI: 10.1002/hep.31458
sha: 70fff518765270695d104f253f5f4d3fc4b26989
doc_id: 1010160
cord_uid: z0kd84gb

In a recent issue of Hepatology, Drs. Qin and Wang report a case of a 37‐year old patient with COVID‐19 disease after undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC). While these are interesting data on the course of COVID‐19 disease in an immunosuppressed patient, we would like to highlight some particularly important issues related to management of liver disease and post‐transplant care.

Third, it would be interesting to know the dosing of the immunosuppressive regimen that was implemented after LT and the corresponding tacrolimus levels. The potential use of ATG as induction therapy and associated leukopenia may put patients at risk for a severe or even fatal course of COVID-19 infection [2] .

The correct diagnosis of acute cellular rejection (ACR) after LT is particularly challenging in the context of COVID-19, which may itself lead to elevated transaminases [3] . After an initial decline in transaminases after LT, AST and ALT increased again and that was the reason why the authors suspected ACR and raised the dose of tacrolimus. COVID-19

infection per se or drug-induced liver injury are alternative reasons why the

This article is protected by copyright. All rights reserved transaminases were rising in this patient, and thus, we would strongly recommend to rely on liver biopsy to prove ACR before increasing immunosuppression. The long course (or relapsing course by PCR) of SARS-CoV-2 infection may have been provoked by the therapy administered for the suspicion of ACR, and thus, it seems essential to use all available diagnostic means (i.e., liver biopsy to assess ACR by histology) prior to raising immunosuppression in a patient with confirmed COVID-19 infection.

Finally, we would like to congratulate the authors for the successful management of this patient despite the current restrictions in health care resources. Moreover, we thank the authors for their important contribution regarding the management of COVID-19 infection in the perioperative setting after LT.

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

COVID-19 in post-transplantation patients-report of two cases

Liver injury in COVID-19: management and challenges