Resuming post living donor liver transplantation in the COVID-19 pandemic: real-life experience, single-center experience

Abeer Awad Abdellatif; Mohamad Sherif Mogawer; Mostafa El-Shazli; Hanaa El-Karaksy; Ayman Salah; Amany Abdel-Maqsod; Mona El-Amir; Mohamed Said; Naglaa Zayed; Karim Hosny; Hadeel Gamal Eldeen; Ayman M A Osman; Doaa A Mansour; Ahmed Nabil; Ahmed Abdel-Ghani; Engy A Mogahed; Noha A Yasin

doi:10.1186/s43066-021-00153-0

Resuming post living donor liver transplantation in the COVID-19 pandemic: real-life experience, single-center experience

Egypt Liver J. 2021;11(1):92. doi: 10.1186/s43066-021-00153-0. Epub 2021 Dec 20.

Authors

Abeer Awad Abdellatif¹, Mohamad Sherif Mogawer¹, Mostafa El-Shazli², Hanaa El-Karaksy³, Ayman Salah², Amany Abdel-Maqsod¹, Mona El-Amir¹, Mohamed Said⁴, Naglaa Zayed⁵, Karim Hosny³, Hadeel Gamal Eldeen⁶, Ayman M A Osman⁷, Doaa A Mansour², Ahmed Nabil², Ahmed Abdel-Ghani¹, Engy A Mogahed³, Noha A Yasin³

Affiliations

¹ Hepatogastroenterology, Liver Transplantation Unit, Internal Medicine Department, Kasr Al-Aini Hospitals, Cairo University, Kasr Al-Aini Street, Cairo, PO: 11451 Egypt.
² Department of General Surgery, Liver Transplantation Unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt.
³ Pediatrics Department, Liver Transplantation Unit, Cairo University, Cairo, Egypt.
⁴ Endemic Medicine, Hepatogastroenterology, Liver Transplantation Unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt.
⁵ Endemic Medicine Department, Liver Transplantation unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt.
⁶ Endemic Hepatology and Gastroenterology, Liver Transplantation Unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt.
⁷ General & HPB Surgery, Department of General Surgery, Unit of Hepatobiliary Surgery, Liver Transplantation Unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt.

Abstract

Background: Solid organ transplantation (SOT) service has been disrupted during the current coronavirus disease 2019 (COVID-19) pandemic, which deferred the service in most centers worldwide. As the pandemic persists, there will be an urgency to identify the best and safest practices for resuming activities as areas re-open. Resuming activity is a difficult issue, in particular, the decision of reopening after a period of slowing down or complete cessation of activities.

Objectives: To share our experience in resuming living donor liver transplantation (LDLT) in the context of the COVID-19 pandemic in the Liver Transplantation Unit of El-Manial Specialized Hospital, Cairo University, Egypt, and to review the obstacles that we have faced.

Material and methods: This study is a single-center study. We resumed LDLT by the 26th of August 2020 after a period of closure from the 1st of March 2020. We have taken a lot of steps in order to prevent COVID-19 transmission among transplant patients and healthcare workers (HCWs).

Results: In our study, we reported three LDLT recipients, once resuming the transplantation till now. All our recipients and donors tested negative for SARS-CoV-2 by nasopharyngeal RT-PCR a day before the transplantation. Unfortunately, one of them developed COVID-19 infection. We managed rapidly to isolate him in a single room, restricting one team of HCWs to deal with him with strict personal protective measures. Finally, the patient improved and was discharged in a good condition. The second patient ran a smooth course apart from FK neurotoxicity which improved with proper management. The third patient experienced a sharp rise in bilirubin and transaminases on day 14 that was attributed to drug toxicity vs. rejection and managed by discontinuing the offending drugs and pulse steroids. In addition, one of our head nurses tested positive for SARS-CoV-2 that was manageable with self-isolation.

Conclusion: Careful patient, donor, personnel screening is mandatory. Adequate supply of personal protective equipments, effective infection control policies, and appropriate administrative modifications are needed for a safe return of LDLT practice.

Keywords: COVID-19; Egypt; Liver transplantation; Single-center experience.