Restarting LDLT During COVID-19: Early Results After Restructuring

Area of Science:

• Hepatology
• Transplant Surgery
• Infectious Diseases

Background:

• Coronavirus disease 2019 (COVID-19) significantly disrupted organ transplantation, particularly living-donor liver transplantation (LDLT).
• Existing LDLT programs faced suspension or considerable reduction in activity due to the pandemic.
• Modified protocols aligned with COVID-19 guidelines were essential for resuming LDLT procedures.

Purpose of the Study:

• To report the outcomes of living-donor liver transplantation (LDLT) performed after protocol modifications during the COVID-19 pandemic.
• To demonstrate the feasibility and safety of LDLT in the context of global COVID-19 restrictions.
• To assess the impact of COVID-19 on LDLT recipients and donors.

Main Methods:

• A month-long moratorium was implemented to restructure LDLT protocols based on global experiences and guidelines.
• Twenty LDLTs were successfully performed between April 18 and September 15 under the revised protocols.
• The study included complex cases such as simultaneous liver-kidney transplants, ABO-incompatible LDLT, and a pediatric LDLT.

Main Results:

• Nineteen out of twenty LDLT recipients recovered successfully, with one patient mortality.
• Major complications occurred in 30% of recipients; no donor complications were reported.
• Postoperative COVID-19 infection occurred in one recipient and a donor-recipient pair after discharge, with full recovery and no impact on liver enzymes.

Conclusions:

• Living-donor liver transplantation (LDLT) is feasible during the COVID-19 pandemic with necessary protocol adjustments.
• The outcomes of LDLT were not adversely affected by COVID-19 itself when appropriate modifications were implemented.
• This experience highlights the adaptability of LDLT programs in managing complex health crises.