Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio.
Transplantation Center, Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio.
Am J Transplant. 2021 Mar;21(3):1312-1316. doi: 10.1111/ajt.16330. Epub 2020 Oct 23.
SARS-CoV2, first described in December 2019, was declared a pandemic by the World Health Organization in March 2020. Various surgical and medical societies promptly published guidelines, based on expert opinion, on managing patients with COVID-19, with a consensus to postpone elective surgeries and procedures. We describe the case of an orthotopic liver transplantation (OLT) in a young female who presented with acute liver failure secondary to acetaminophen toxicity to manage abdominal pain and in the setting of a positive SARS-CoV2 test. Despite a positive test, she had no respiratory symptoms at time of presentation. The positive test was thought to be residual viral load. The patient had a very favorable outcome, likely related to multiple factors including her young age, lack of respiratory COVID-19 manifestations and plasma exchange peri-operatively. We recommend a full work-up for OLT in COVID-19 patients with uncomplicated disease according to standard of care, with careful interpretation of COVID-19 testing in patients presenting with conditions requiring urgent or emergent surgery as well as repeat testing even a few days after initial testing, as this could alter management.
SARS-CoV2，于 2019 年 12 月首次描述，世界卫生组织于 2020 年 3 月宣布其为大流行。各种外科和医学协会迅速根据专家意见发布了管理 COVID-19 患者的指南，共识是推迟择期手术和程序。我们描述了一位年轻女性的原位肝移植（OLT）病例，她因服用对乙酰氨基酚而导致急性肝功能衰竭，表现为腹痛，并伴有 SARS-CoV2 检测呈阳性。尽管检测呈阳性，但她在就诊时没有呼吸道症状。阳性检测结果被认为是残留的病毒载量。患者的预后非常有利，可能与多种因素有关，包括她年轻、无 COVID-19 呼吸道表现以及围手术期进行了血浆置换。我们建议根据标准护理对 COVID-19 患者进行全面的 OLT 检查，对需要紧急或急诊手术的患者的 COVID-19 检测结果进行仔细解释，以及即使在初次检测几天后也要重复检测，因为这可能会改变治疗方案。
