Clinics (Sao Paulo). 2020;75:e2377.
Enabling liver transplantation during the COVID-19 era: More than screening donors and recipients for SARS-CoV-2
Edson Abdala
, Daniel Reis Waisberg
, Luciana Bertocco Haddad
, Liliana Ducatti
, Vinicius Rocha-Santos
, Rodrigo Bronze de Martino
, Wellington Andraus
, Luiz Augusto Carneiro-D’Albuquerque
DOI: 10.6061/clinics/2020/e2377
The consequences of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in the early postoperative course after liver transplantation (LT) are still not fully known. While data is scarce, it indicates that the incidence of early post-transplant coronavirus disease-19 (COVID-19) may reach up to 38% (). Some centers have developed strategies for performing LT during the pandemic and, after implementing a multimodal stepwise approach, these facilities could minimize the risk of recipient SARS-CoV-2 infection (,). These measures may be summarized as establishing physically separated hospital facilities and in-hospital barrier protocols, performing rapid donor and recipient screening for SARS-CoV-2 once the organ becomes available, and optimizing recipient selection (,). We would like to share our experience, in which we initially observed a high post-LT COVID-19 infection rate in the first month of the pandemic, however we were able to reduce it significantly by adopting a similar approach, most notably by intensifying and expanding our barrier protocols.
Our institution, the Clinics Hospital of the University of São Paulo Medical School (HCFMUSP), is a medical complex located in São Paulo, Brazil, a city severely affected by SARS-CoV-2, with 160,337 confirmed cases documented by 1 July 2020. It is a public quaternary hospital and a major transplant center in Latin America, and it became the main referral center for severe COVID-19 cases when a city-wide quarantine was declared on March 24th. To maintain LT activity, a building specifically dedicated to non-COVID-19 patients was established. Second, we developed rapid screening protocols for donors and recipients, including epidemiological and clinical evaluation, real-time polymerase chain�reaction (RT-PCR) for SARS-CoV-2 from respiratory secretions, and chest computed tomography scans. Third, we tried to avoid using expanded-criteria donors and aimed to transplant more critical cases (i.e. patients with down-staged hepatocellular carcinoma or those with high model of end-stage liver disease scores, but with expected lower intensive care unit (ICU) stay), and fulminant hepatic failure cases. Finally, patients on the waiting list were fully informed about the risks of transplantation during the pandemic and we emphasized the importance of self-isolation afterwards.
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