key: cord-259572-8n12n6ym authors: Bogensperger, Christina; Cardini, Benno; Oberhuber, Rupert; Weissenbacher, Annemarie; Gasteiger, Silvia; Berchtold, Valeria; Otarashvili, Giorgi; Öfner, Dietmar; Schneeberger, Stefan title: Dealing with liver transplantation in the SARS-CoV-2 pandemic: Normothermic machine perfusion enables for donor, organ and recipient assessment – A Case Report date: 2020-07-22 journal: Transplant Proc DOI: 10.1016/j.transproceed.2020.07.011 sha: doc_id: 259572 cord_uid: 8n12n6ym Abstract The SARS-CoV-2 pandemic has changed life on a global scale. The numbers in transplantation have plumped in fear of disease transmission, recipient Covid-19 infection, priority shift and resource limitations. Covid-19 complicates transplantation since donor testing, (re)allocation of limited resources and recipient testing may exceed permissible ischemia times. Normothermic machine perfusion (NMP) helps to safely prolong liver preservation up to 38 hours. Additional time is essential under the current circumstances. Here we present the case of a 29-year-old liver transplant recipient, in whom prolonged liver preservation required for SARS-CoV-2 screening was accomplished through normothermic machine perfusion (NMP). Donor and recipient test results for SARS-CoV-2 were negative and intensive care unit (ICU) capacity eventually available. The surgical procedure and postoperative course were uneventful. NMP offers to extend preservation times in liver transplantation while awaiting SARS-CoV-2 test results and availability of ICU capacity. exceed permissible ischemia times. Normothermic machine perfusion (NMP) helps to safely prolong liver preservation up to 38 hours. Additional time is essential under the current circumstances. Here we present the case of a 29-year-old liver transplant recipient, in whom prolonged liver preservation required for SARS-CoV-2 screening was accomplished through normothermic machine perfusion (NMP). Donor and recipient test results for SARS-CoV-2 were negative and intensive care unit (ICU) capacity eventually available. The surgical procedure and postoperative course were uneventful. NMP offers to extend preservation times in liver transplantation while awaiting SARS-CoV-2 test results and availability of ICU capacity. Hence, SARS-CoV-2 screening prior to transplantation is recommended (4) . Here we present the case of a liver transplant recipient, in whom prolonged liver preservation required for SARS-CoV-2 screening was accomplished through normothermic machine preservation (NMP), which we have recently established as a routine in liver transplantation (6). The donor was a 66-year-old brain dead female with bacterial meningitis caused by streptococcus pyogenes as underlying cause of death. Donor demographics are shown in table 1. The donor risk index (DRI) was 2.04 and the donor met expanded criteria donor (ECD) criteria (7). As per recommendations and local policy, the donor was screened for SARS-CoV-2 and test results were awaited prior to organ procurement. The liver was allocated to a 29-year old woman with end-stage liver disease due to primary biliary cholangitis (PBC) and overlapping autoimmune hepatitis (AIH) with a MELD (Model for End-stage Liver Disease) of 20. Following the hospital safety measures, a telephone questionnaire was performed to exclude exposure or symptoms of infection. Since the patient resided in a SARS-CoV-2 high risk region (8) as declared by the world health organization (WHO) and Robert Koch Institute, SARS-CoV-2 screening prior to admission at the transplant unit was performed. A nasopharyngeal swap was analysed for SARS-CoV-2 by RT-PCR, and a thoracic x-ray and lab work were performed. The recipient remained under pre-emptive isolation while awaiting the results. Following procurement of the organ, the liver was stored and transported according to cold storage routines. Total cold preservation time was 5 hours and 36 minutes upon arrival at the recipient center. On the basis of prolonged waiting time for SARS-CoV-2 test results of the recipient, as well as the ECD-status of the donor liver requiring extensive liver quality and functional assessment as well as the limited OR capacity, we opted to place the donor liver on a NMP device. Total NMP time was 10 hours and 36 minutes and total preservation time reached 16 hours and 11 minutes (Table 1) . Perfusate was collected as per protocol (7) This is a profoundly unspectacular case report. NMP of the donor liver is a novel preservation method in liver transplantation. It enables to shorten or eliminate cold storage, but also to perfuse and assess the organ ex vivo (6) . This is a fundamental advancement for the field, since organ quality can be assessed more precisely prior to transplantation. Further to this, the factor of time for logistics and recipient testing become ultimately apparent in the conditions and circumstances arising with the COVID-19 pandemic. Assessing the organ quality, while awaiting COVID-19 test results illustrates the multifactorial benefit of this technology and its relevance and potential for any kind of situations, where more testing is required before an organ can be safely transplanted. 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A case report COVID-19 in posttransplantation patients-report of two cases Negative Nasopharyngeal and Oropharyngeal Swab Does Not Rule Out COVID-19 Disclaimer SS declares the following conflict of interest: Honoraria: Astellas Funding The work was funded by the Normothermic Liver Preservation and Conditioning Trial (Oncologic Transplant Surgery Project)