key: cord-0798624-1yru18ad
authors: Jadaun, Shekhar Singh; Saigal, Sanjiv; Hasnain, Ana; Singh, Shweta; Das, Dibyajyoti; Agarwal, Shaleen; Gupta, Subhash
title: ABO incompatible Living Donor Related Liver Transplant in COVID-19 pandemic: Challenges and Outcomes
date: 2022-04-03
journal: Journal of Liver Transplantation
DOI: 10.1016/j.liver.2022.100089
sha: c6f532c0cce79d826ecfb91d4a46bf84eef65035
doc_id: 798624
cord_uid: 1yru18ad

nan

Total 22(9.48%) ABOi LDLT (18 adult, 4 paediatrics) were performed during this period. All these patients had advance liver failure with average MELD and CTP scores of 24.8 and 10.6 respectively. All living liver donors were blood relative of their respective recipients. Strict COVID-19 protocols were in place for all patients and health care workers. Both donor and recipient were required to have a negative COVID-19 RT-PCR test 24 hour prior to surgery.

Donors were advised to stay near to hospital to minimize contact with other persons and follow COVID-19 appropriate behaviour. Also, healthcare staff were vaccinated on priority basis once it became available. Donors were also vaccinated at least 4 weeks before planned surgery. If donor contracted SARS-CoV-2 before surgery, they were immediately isolated and managed as per protocol. A four-week period of observation after negative swab test for SARS-CoV-2 was mandatory before a donor could be considered suitable for surgery. In desensitization protocol at our centre, rituximab was given 2 weeks prior to transplant surgery followed by therapeutic plasma exchange or immunoadsorption to decrease the isohemagglutinins titres before the surgery. One or more sessions of therapeutic plasma exchange or immunoadsorption were done to achieve the iso hemagglutinins (IHA) target One patient died due complications related to multiple biliary strictures. Early graft 

Bile leak n (%) 4(18.2%) Acute rejection n (%) 6 (27.3 %)

Hepatic artery thrombosis n (%) 0 Portal vein thrombosis n (%) 0 Hepatic vein thrombosis n (%) 2 (11.8%) Sepsis n (%) 2(9.1%) Biliary stricture 3(13.6%) Survival at 6-month posttransplant n (%)

COVID-19 pandemic and worldwide organ transplantation: a population-based study. Lancet Public Health

Liver transplantation and COVID-19 (Coronavirus) infection: guidelines of the liver transplant Society of India (LTSI)

ABO-incompatible liver transplantation: Is it a viable option with modern innovation?: Viability of ABO-Incompatible LT. Clin Liver Dis

dysfunction with sepsis and multiorgan failure was the cause of mortality in rest 2 patients.Despite having higher pretransplant MELD score 180 days survival was 81.8 %. In conclusion, ABOi LDLT has optimal survival outcomes and is feasible in challenging times like COVID-19 pandemic.