Transplant of SARS-CoV-2-infected Living Donor Liver: Case Report

Michelle C Nguyen; Eliza J Lee; Robin K Avery; M Veronica Dioverti-Prono; Shmuel Shoham; Aaron A R Tobian; Evan M Bloch; Ahmet Gurakar; Nicole A Rizkalla; Andrew M Cameron; Elizabeth A King; Shane Ottmann; Jacqueline M Garonzik-Wang; Russel N Wesson; Benjamin Philosophe

doi:10.1097/TXD.0000000000001178

Transplant of SARS-CoV-2-infected Living Donor Liver: Case Report

Transplant Direct. 2021 Jul 8;7(8):e721. doi: 10.1097/TXD.0000000000001178. eCollection 2021 Aug.

Authors

Michelle C Nguyen¹, Eliza J Lee¹, Robin K Avery², M Veronica Dioverti-Prono², Shmuel Shoham², Aaron A R Tobian³, Evan M Bloch³, Ahmet Gurakar⁴, Nicole A Rizkalla⁵, Andrew M Cameron^{1

6}, Elizabeth A King¹, Shane Ottmann¹, Jacqueline M Garonzik-Wang^{1

6}, Russel N Wesson¹, Benjamin Philosophe¹

Affiliations

¹ Division of Transplant Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
² Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
³ Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD.
⁴ Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.
⁵ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
⁶ Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.

Abstract

Given the high community prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), transplant programs will encounter SARS-CoV-2 infections in living donors or recipients in the perioperative period. There is limited data on SARS-CoV-2 viremia and organotropism beyond the respiratory tract to inform the risk of transplant transmission of SARS-CoV-2. We report a case of a living donor liver transplant recipient who received a right lobe graft from a living donor with symptomatic PCR-confirmed SARS-CoV-2 infection 3 d following donation. The donor was successfully treated with remdesivir, dexamethasone, and coronavirus disease 2019 (COVID-19) convalescent plasma. No viral transmission was identified, and both donor and recipient had excellent postoperative outcomes.