Jha Sandeep K, Jamir Imtiakum, Sisodia Kshitij, Kumar Niteen, Sood Gaurav, Shanker Nitin, Anand Sachin, Dubey Gaurav, Choudhary Vinod, Lohia Pankaj, Singhal Amit, Wadhawan Manav, Kumar Ajay, Chaudhary Abhideep
Department of HPB Surgery & Liver Transplant, BL Kapur Superspeciality Hospital, Delhi, India.
Department of HPB Surgery & Liver Transplant, BL Kapur Superspeciality Hospital, Delhi, India.
Transplant Proc. 2021 May;53(4):1118-1125. doi: 10.1016/j.transproceed.2020.10.049. Epub 2020 Dec 16.
Living-donor liver transplantation (LDLT) has been mostly suspended and deceased-donor living transplantation activity has been considerably reduced because of coronavirus disease 2019 (COVID-19). We modified our protocols and procedures in line with COVID-19 guidelines. Since the restructuring, we have performed 20 LDLTs. Our study reports the outcomes of these cases and demonstrates the feasibility of LDLT during this pandemic.
The changes were influenced by experiences and communications from across the globe. A month-long self-imposed moratorium was spent in restructuring the program and implementing new protocols. Twenty LDLTs were performed between April 18 and September 15 using the new protocols. Our experience includes 2 simultaneous liver-kidney transplants, 1 ABO-incompatible LDLT, and 1 pediatric case (age 11 months).
Nineteen patients recovered and 1 patient died. We maintained our postoperative immunosuppression protocol without many changes. Major complications were observed in 30% of recipients but none of the donors. One recipient was infected with COVID-19 during the postoperative period. A donor-recipient couple contracted COVID-19 after discharge from the hospital. All patients recovered from COVID-19 and liver enzymes were unaffected.
This study represents a microcosm of experience in LDLT during the COVID-19 era. Outcomes of LDLT are not affected by COVID-19 per se, provided that we make necessary changes.
由于2019冠状病毒病（COVID-19），活体肝移植（LDLT）大多已暂停，脑死亡供体肝移植活动也大幅减少。我们根据COVID-19指南修改了我们的方案和程序。自重组以来，我们已进行了20例LDLT。我们的研究报告了这些病例的结果，并证明了在此次大流行期间进行LDLT的可行性。
这些改变受到全球经验和交流的影响。我们花了一个月的时间自行暂停，对项目进行重组并实施新方案。4月18日至9月15日期间，使用新方案进行了20例LDLT。我们的经验包括2例肝肾联合移植、1例ABO血型不相容的LDLT和1例儿科病例（11个月大）。
19例患者康复，1例患者死亡。我们维持术后免疫抑制方案，没有太多变化。30%的受者出现了严重并发症，但供者均未出现。1例受者在术后感染了COVID-19。一对供受者夫妇在出院后感染了COVID-19。所有患者均从COVID-19中康复，肝酶未受影响。
本研究代表了COVID-19时代LDLT经验的一个缩影。只要我们做出必要的改变，LDLT的结果不会受到COVID-19本身的影响。
