Effect of SARS CoV-2 Infection among Potential Liver Transplant Recipients and Living Donors on the Outcome of Living Donor Liver Transplantation

Abstract Background Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a substantial risk of morbidity and mortality. Liver transplantation has faced unique challenges due to COVID-19 all over the world. There is a scarce data on the effects of SARS-CoV-2 infection in candidates awaiting liver transplantation or potential donors who proved to have SARS CoV-2 infection based on clinical and/or positive RT- PCR test and/or radiological data. Objective To describe the effect of preoperative SARS-CoV 2infection in potential candidates and living donors on the outcome of living donor liver transplantation (LDLT). Patients and Methods Combined retrospective and prospective pilot cohort study carried out at Ain Shams Center for Organ Transplantation (ASCOT). 74 LDLT recipients & their donors were included, who underwent LDLT operation during the interval between January 2020 and august 2022. were classified into two groups: Group A: included candidate recipients and/or living donor who had preoperative SARS-CoV-2 infection and Group B (control group): included candidate recipients and/or living donor who didn't have preoperative SARS-CoV-2 infection. The two groups were followed post LDLT for a minimum duration of 6 months and maximum duration of 2.5 years. Their data were analysed and compared. Results Among the 74 LDLT recipients, 10 recipients (13.5%) & 8 donors (10.8%) had confirmed preoperative SARS-COV2. The mean age of the recipients was 46.90 ± 14.15 years old with male prevalence, and the majority had mild respiratory symptoms of preoperative COVID-19. Two patients have specific treatment for COVID-19 with remdesivir or steroid therapy and supplemental oxygen and 8 patients received only symptomatic treatment. The median time between SARS Cov2 infection and LT in our series was 6.5 months. there was no significant difference between candidates/recipients who had preoperative COVID-19 (group-a) and those who hadn’t (group-b), regarding the preoperative, operative and postoperative characteristics apart from significantly shorter duration of operation and higher incidence of early postoperative desaturation in ICU in (group a, 20% vs 1.6% in group b patients, p: 0.006) Table (1). The mean age of the living donors of group a was 30.25 ± 7.07, all had mild preoperative COVID 19 disease which didn’t affect significantly their operative and postoperative course Table (2). Conclusion Mild preoperative COVID-19 disease didn’t affect significantly the postoperative course of recipients for LDLT. Donors with completely resolved mild preoperative COVID-19 disease can safely donate for LDLT.