key: cord-0695378-8996sdp8
authors: Vissichelli, Nicole C.; Morales, Megan K.; Bryson, Alexandra; Bruno, David
title: Successful deceased donor liver transplantation in candidates with high MELD and ongoing positive SARS‐CoV‐2 PCR
date: 2022-03-02
journal: Transpl Infect Dis
DOI: 10.1111/tid.13816
sha: 3ca066a138e259a9a92ca665d512d83a696a6471
doc_id: 695378
cord_uid: 8996sdp8

nan

Prior studies have found increased risk of mortality in the setting of symptomatic infection or preoperative COVID-19 infection less than 7 weeks prior to elective or emergent surgery, with at 3.6-4.1 times higher odds of death within 6 weeks of diagnosis. 4 However, delaying transplantation pending a negative test in patients with high MELD and prolonged active infection or viral shedding can risk increased mortality. The viral load in a patient's SARS-CoV-2 PCR test can be approximately quantified using the cycle threshold (Ct) value. Different reports suggest lower Ct values associated with higher viral load, viral recovery and more severe illness; therefore, this may aid in the pretransplant evaluation. 5, 6 The values that have shown to not be associated with cell culture viral recovery or range from >24 (especially after 8 days from symptom onset) to 34. 5, 7, 8 We present two patients who underwent successful deceased donor liver transplantation (DDLT) with a positive SARS-CoV-2 nasopharyngeal PCR. indirect marker of viral load, may be useful in assessing candidacy. 10, 11 The decision of the timing to pursue liver transplant in the setting of high MELD and recent COVID-19 infection remains complicated and requires careful pretransplant evaluation based on individual risk and benefit. While delaying surgery at least 7 weeks is preferred to minimize postoperative mortality and allow for conversion to negative PCR testing, this may not be feasible for patients awaiting liver transplantation who are at high risk for morality due to their underlying disease.

These cases suggest that it is feasible to pursue DDLT at a shorter time interval depending on careful individual risk assessment and considering the limited resource of an organ.

Nicole C. Vissichelli 1

Early impact of COVID-19 on transplant center practices and policies in the United States

Clinical best practice advice for hepatology and liver transplant providers during the COVID-19 pandemic: AASLD Expert Panel Consensus Statement

Successful liver transplantation in a patient recovered from COVID-19

Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study

A narrative systematic review of the clinical utility of cycle threshold values in the context of COVID-19

Viral isolation analysis of SARS-CoV-2 from clinical specimens of COVID-19 patients

Predicting infectious severe acute respiratory syndrome coronavirus 2 from diagnostic samples

Persistence of live virus in critically ill patients infected with SARS-COV-2: a prospective observational study

REGN-COV2, a neutralizing antibody cocktail, in outpatients with Covid-19

Repeat COVID-19 molecular testing: correlation of SARS-CoV-2 culture with molecular assays and cycle thresholds

Relationship of the cycle threshold values of SARS-CoV-2 polymerase chain reaction and total severity score of computerized tomography in patients with COVID 19