Restructuring Living-Donor Liver Transplantation at a High-Volume Center During the COVID-19 Pandemic

Arvinder S Soin; Narendra S Choudhary; Sanjay K Yadav; Sanjiv Saigal; Neeraj Saraf; Amit Rastogi; Prashant Bhangui; Thiagarajan Srinivasan; Neelam Mohan; Sujeet K Saha; Ankur Gupta; Rohan J Chaudhary; Kamal Yadav; Swapnil Dhampalwar; Deepak Govil; Nikunj Gupta; Vijay Vohra

doi:10.1016/j.jceh.2020.09.009

Restructuring Living-Donor Liver Transplantation at a High-Volume Center During the COVID-19 Pandemic

J Clin Exp Hepatol. 2021 Jul-Aug;11(4):418-423. doi: 10.1016/j.jceh.2020.09.009. Epub 2020 Oct 8.

Authors

Arvinder S Soin¹, Narendra S Choudhary¹, Sanjay K Yadav¹, Sanjiv Saigal¹, Neeraj Saraf¹, Amit Rastogi¹, Prashant Bhangui¹, Thiagarajan Srinivasan¹, Neelam Mohan², Sujeet K Saha¹, Ankur Gupta¹, Rohan J Chaudhary¹, Kamal Yadav¹, Swapnil Dhampalwar¹, Deepak Govil³, Nikunj Gupta⁴, Vijay Vohra⁴

Affiliations

¹ Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurgaon, Delhi (NCR), India.
² Paediatric Gastroenterology and Hepatology, Medanta the Medicity, Gurgaon, Delhi (NCR), India.
³ Critical Care, Medanta the Medicity, Gurgaon, Delhi (NCR), India.
⁴ Liver Transplant Anesthesia, Medanta the Medicity, Gurgaon, Delhi (NCR), India.

Abstract

Background: Coronavirus disease 2019 (COVID-19) pandemic has led to deferral of elective transplants and proactive pretransplant testing of the donor/recipient. The impact of these on living-donor liver transplantation (LDLT) activity and outcome is not known. We performed LDLT only for sick patients or patients with advanced hepatocellular carcinoma in this period, with special COVID protocols.

Methods: Patients undergoing LDLT counseling, evaluation, and transplant in the period March to June 2020 (group A) under COVID-19 restrictions and special protocols were included. LDLT activity and outcomes among these patients were compared with those in the same period in 2019 (group B).

Results: In the period March 15-June 10, we performed 39 and 23 (59%) LDLTs in 2019 and 2020, respectively. The adult patients with cirrhosis in group A (n = 20) had a significantly higher MELD score, 19.8 ± 7.0 versus 16.1 ± 5.6 in group B (n = 36), p = 0.034. Early recipient mortality was similar in 2019 (2/39) and 2020 (2/23). One of 23 post-transplant recipients, 3/71 recipients and donors during evaluation, and 8/125 healthcare workers (HCWs) developed COVID-19, all of whom recovered uneventfully.

Conclusion: LDLT activity substantially reduced during the COVID era. The incidence and outcome of COVID-19 among the waiting or transplanted patients and HCWs were similar to those of the general population. The outcome after LDLT in the COVID era was similar to that in non-COVID times. These data suggest that LDLT may be extended to more stable patients with strict protocols.

Keywords: COVID; COVID-19, Coronavirus disease 2019; CTP score; Cirrhosis; Disease severity; HCC, hepatocellular carcinoma; HCWs, healthcare workers; Hepatocellular carcinoma; India; LDLT, living-donor liver transplantation; LTSI, Liver Transplantation Society of India; Lockdown; MDT, multidisciplinary team; MELD score; PPE, personal protective equipment; Pandemic.