The impact of the COVID-19 outbreak on liver transplantation programs in Northern Italy

Area of Science:

• Medicine
• Virology
• Transplant Surgery

Background:

• The COVID-19 pandemic caused significant disruption to healthcare systems globally, including liver transplantation (LT).
• Lombardy, Italy, was severely impacted, with a high COVID-19 mortality rate and increased ICU bed demand.
• A notable decrease in liver donor availability was observed during the pandemic.

Purpose of the Study:

• To evaluate the safety and feasibility of continuing liver transplantation (LT) programs during the COVID-19 pandemic.
• To report on the outcomes of LT procedures performed in a highly affected region.
• To identify key lessons learned from managing LT during a viral outbreak.

Main Methods:

• Retrospective analysis of 17 liver transplantation (LT) procedures performed in Lombardy between February 23rd and April 10th.
• Screening of all donors for SARS-CoV-2 prior to LT.
• Monitoring of recipient outcomes, including post-transplant SARS-CoV-2 status and survival rates.

Main Results:

• Seventeen liver transplantations (LTs) were performed with a mean donor age of 49 and recipient age of 55.
• Two recipients tested positive for SARS-CoV-2 post-LT, and one patient died on post-operative day 30 due to COVID-19.
• Sixteen patients survived an average of 30 days post-LT, with 10 discharged, indicating no specific recipient safety concerns.

Conclusions:

• No specific safety concerns for recipients necessitate the complete cessation of liver transplantation (LT) programs during the pandemic.
• While continuation is possible, a reduction in LT activity may be a pragmatic approach due to the complex circumstances of the viral outbreak.
• Experience gained provides valuable lessons for managing LT in future infectious disease crises.