Journal
AMERICAN JOURNAL OF TRANSPLANTATION
Volume 21, Issue 3, Pages 1312-1316Publisher
ELSEVIER SCIENCE INC
DOI: 10.1111/ajt.16330
Keywords
clinical research; practice; drug toxicity; fulminant hepatic failure; infection and infectious agents – viral; infectious disease; liver transplantation; hepatology; plasmapheresis; plasma exchange
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A young female with acute liver failure due to acetaminophen toxicity and positive SARS-CoV2 test underwent orthotopic liver transplantation with a favorable outcome. It is recommended to conduct a full work-up for OLT in COVID-19 patients with uncomplicated disease, and to carefully interpret COVID-19 testing results and consider repeat testing in patients requiring urgent or emergent surgery.
SARS-CoV2, first described in December 2019, was declared a pandemic by the World Health Organization in March 2020. Various surgical and medical societies promptly published guidelines, based on expert opinion, on managing patients with COVID-19, with a consensus to postpone elective surgeries and procedures. We describe the case of an orthotopic liver transplantation (OLT) in a young female who presented with acute liver failure secondary to acetaminophen toxicity to manage abdominal pain and in the setting of a positive SARS-CoV2 test. Despite a positive test, she had no respiratory symptoms at time of presentation. The positive test was thought to be residual viral load. The patient had a very favorable outcome, likely related to multiple factors including her young age, lack of respiratory COVID-19 manifestations and plasma exchange peri-operatively. We recommend a full work-up for OLT in COVID-19 patients with uncomplicated disease according to standard of care, with careful interpretation of COVID-19 testing in patients presenting with conditions requiring urgent or emergent surgery as well as repeat testing even a few days after initial testing, as this could alter management.
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