Wall Anji E, McKenna Gregory J, Onaca Nicholas, Ruiz Richard, Bayer Johanna, Fernandez Hoylan, Martinez Eric, Gupta Amar, Askar Medhat, Spak Cedric W, Testa Giuliano
Baylor Simmons Transplant Institute, Dallas, Texas.
Department of Pathology and Laboratory Medicine, Texas A&M Health Science Center College of Medicine, Dallas, Texas.
Proc (Bayl Univ Med Cent). 2021 Oct 15;35(1):62-63. doi: 10.1080/08998280.2021.1985888. eCollection 2022.
Liver transplantation rates have been negatively affected by the pandemic caused by coronavirus disease 2019 (COVID-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Current practice in the liver transplant community is to avoid utilizing SARS-CoV-2-positive donors for liver transplantation unless there is a compelling reason such as recipient illness severity. In this case, we report the use of a donor who had a positive exposure to and symptom history for COVID-19 and tested positive for SARS-CoV-2 on admission for a liver transplant recipient with primary sclerosing cholangitis and a Model of End-Stage Liver Disease score of 23 with no known COVID-19 exposures. We focus on the decision to accept this particular organ, as well as the discussion with the recipient about the unknowns of disease transmission and risk associated with this donor. The current case argues that transplant programs should begin to consider low-risk donors with positive SARS-CoV-2 testing for recipients who have the potential to benefit from liver transplantation, which may not only be those with the most severe illness.
肝移植率受到2019冠状病毒病（COVID-19）大流行的负面影响，COVID-19是由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的疾病。肝移植界目前的做法是避免将SARS-CoV-2阳性供体用于肝移植，除非有令人信服的理由，如受者病情严重程度。在此，我们报告了一名供体的情况，该供体曾接触过COVID-19并有相关症状史，在因原发性硬化性胆管炎入院接受肝移植时SARS-CoV-2检测呈阳性，而该肝移植受者终末期肝病模型评分23，且无已知COVID-19暴露史。我们重点关注接受这个特定器官的决策，以及与受者关于疾病传播未知情况及该供体相关风险的讨论。当前案例表明，移植项目应开始考虑对有可能从肝移植中获益的受者使用SARS-CoV-2检测呈阳性的低风险供体，受益人群可能不仅是病情最严重的患者。
