Graft Injury and Re-transplantation in Liver Transplant patients with COVID-19

Ng, Alexander

This article discusses the current scene of liver transplantation (LT) in light of the impact of COVID-19, with particular emphasis on the possibility of graft injury and re-transplantation in LT patients infected with SARS-CoV-2. A major concern is whether such patients experience more severe form of disease thus higher risk of acute, irreversible liver injury. If serious, this may necessitate re-transplantation. It aims to raise awareness in this relatively under-researched domain. More studies are required to evaluate the issue since it has strong implications in healthcare resource allocation and clinical decision-making. Several potential research directions are proposed, including the possibility of prolonging bridging therapy for non-urgent LT cases in patients with hepatocellular carcinoma and whether hepatoprotective agents play a role in liver-sparing during SARS-CoV-2 infection. There is also discussion of the relevance of lung injury in LT patients with COVID-19 since it is not uncommon regarding the high expression of ACE2 receptors in the lungs, and that lung injury remains the major cause of death in patients with chronic liver disease.