Strategies for Liver Transplantation during the SARS CoV‐2 Outbreak Preliminary Experience from a Single Center in France

Muller, Xavier; Tilmans, Gilles; Chenevas‐Paule, Quentin; Lebosse, Fanny; Antonini, Teresa; Poinsot, Domitille; Rode, Agnes; Guichon, Céline M; Schmitt, Zoé; Ducerf, Christian; Mohkam, Kayvan; Lesurtel, Mickaël; Mabrut, Jean‐Yves

Liver transplantation during the ongoing SARS‐CoV‐2 pandemic is challenging given the urgent need to reallocate resources to other areas of patient care. Available guidelines recommend to reorganize transplant care but data on clinical experience in the context of SARS‐CoV‐2 pandemic are scarce. Thus, we report strategies and preliminary results in liver transplantation during the peak of the SARS‐CoV‐2 pandemic from a single‐center in France. Our strategy to reorganize the transplant program included four main steps: optimization of available resources especially intensive care unit capacity, multidisciplinary risk stratification of liver transplantation candidates on the waiting list, implementation of a systematic SARS‐CoV‐2 screening strategy prior to transplantation and definition of optimal recipient‐donor matching. After implementation of these four steps, we performed 10 successful liver transplantations during the peak of the pandemic with a short median intensive care unit stay (2,5 days), benchmark post‐transplant morbidity and no occurrence of SARS‐CoV‐2 infection during follow‐up. From this preliminary experience we conclude that efforts in resource planning, optimal recipient selection and organ allocation strategy are key to maintain a safe liver transplant activity. Transplant centers should be ready to readapt their practices as the pandemic evolves.