Successful management of COVID-19 infection in two early post-liver transplant recipients

Dale, Miles; Sogawa, Hiroshi; Seyedsasdat, Arman; Wolf, David C; Bodin, Roxana; Partiula, Bernard; Nog, Rajat; Latifi, Rifat; John, Devon; Veillete, Gregory; Diflo, Thomas; Nishida, Seigo

Background Coronavirus disease 2019 (COVID-19) has affected all facets of life and continues to cripple nations. COVID-19 has taken the lives of more than 2.1 million people worldwide (23), with a global mortality rate of 2.2% (23). Current COVID-19 treatment options include supportive respiratory care, parenteral corticosteroids, and Remdesivir. Although COVID-19 is associated with increased risk of morbidity and mortality in patients with comorbidities, the vulnerability, clinical course, optimal management, and prognosis of COVID-19 infection in patients with organ transplants has not been well described in the literature (9, 13). The treatment of COVID-19 differs, based on the organ(s) transplanted (6). Preliminary data suggested that liver transplant patients with COVID-19 did not have higher mortality rates than untransplanted COVID-19 patients (2). Table 1 depicts a compiled list of current published data on COVID-19 liver transplant patients. Most of these studies included both recent and old liver transplant patients. No distinction was made for early liver transplant patients who contract COVID-19 within their post-transplant hospitalization course. This potential differentiation needs to be further explored (14). Here, we report two patients who underwent liver transplantation who acquired COVID-19 during their post-transplant recovery period in the hospital. Case Descriptions Two patients who underwent liver transplant and contracted COVID-19 in the early post-transplant period. Treated with hydroxychloroquine, methylprednisolone, tocilizumab and convalescent plasma. Description of their hospital course, including treatment and recovery. Conclusions The management of post-liver transplant patients with COVID‐19 infection is complicated. Strict exposure precaution practice following organ transplantation is highly recommended. Widespread vaccination will help with prevention, but there will continue to be patients who contract COVID-19. Therefore, continued research into appropriate treatments is still relevant and critical. A temporary dose reduction of immunosuppression and continued administration of low-dose methylprednisolone, remdesivir, monoclonal antibodies, and convalescent plasma might be helpful in the management and recovery of severe COVID-19 pneumonia in post-liver transplant patients. Future studies and experiences from post-transplant patients are warranted to better delineate the clinical features and optimal management of COVID-19 infection in liver transplant recipients.