COVID-19 infection in a child following liver transplantation

COVID-19 infection immediately after liver transplantation presents a unique and challenging situation. In this report, we present the case of an 11-year-old girl who underwent emergency living donor liver transplantation for acute liver failure. After an uneventful intra-operative course, the patient was transferred to the intensive care unit. On the second postoperative day, the patient developed unexplained severe hypoxia. A polymerase chain reaction test was positive for SARS-CoV-2 virus and a hypercoagulable state was indicated by laboratory investigations. Despite therapies such as mechanical ventilation and therapeutic anticoagulation, further clinical deterioration occurred. On the seventh postoperative day, the patient's pupils were fully dilated bilaterally and unreactive to light, and brain death was later confirmed. This report highlights unique challenges pertaining to oxygenation, coagulation and immunosuppression after liver transplantation in a child with COVID-19. Hypoxia of unknown origin in the postoperative period should prompt consideration of COVID-19 as a possible cause.