Impact of the COVID-19 pandemic on liver donation and transplantation: A review of the literature

Table 2 Recommendations of international societies

	AASLD[58]	EASL[51]	APASL[32]
Donor screening	RT-PCR for SARS-CoV-2. Screen for exposure and clinical symptoms/fever compatible with COVID-19. Additionally, consider chest X-ray	RT-PCR for SARS-CoV-2	SARS-COV-2 RNA on NPS or BAL. Exclude any evidence of COVID-19 infection on chest CT scan
Recipient testing	Screen for exposure and clinical symptoms/fever compatible with COVID-19. RT-PCR for SARS-CoV-2	Evaluation of clinical history, chest radiology, and SARS-CoV-2 testing. Screening before admission	Assess recipients for COVID-19 infection, particularly in the presence of symptoms or contact with a known COVID-19 case
Liver allocation policy	High MELD scores. HCC based on their risk of drop-out and disease progression	Acute liver failure. ACLF. High MELD score. HCC at the upper limits of the Milan criteria	Acute liver failure. High MELD. High risk of HCC progression
Living donation	Consider suspending, except for pediatric patients with acute liver failure	Should be considered on a case-by-case basis	Not specified (avoid if evidence of COVID-19 infection)
Immunosuppression in COVID-19 positive recipients	Standard immunosuppression protocol. Reduction of immunosuppression may be considered in the setting of lymphopenia, fever, or worsening pulmonary status	Standard immunosuppression protocol. Reduction should only be considered under special circumstances	Standard immunosuppression protocol. Reduction of immunosuppression may be considered in patients diagnosed with moderate COVID-19 infection

AASLD: American Association for the Study of Liver Diseases; ACLF: Acute on chronic liver failure; APASL: Asian-Pacific Association for the Study of the Liver; BAL: Bronchoalveolar lavage; CT: Computerized tomography; EASL: European Association for the Study of the Liver; HCC: Hepatocellular carcinoma; MELD: Model for end stage liver disease; NAT: Nucleic acid test; RT-PCR: Reverse transcription-polymerase chain reaction; SARS-CoV-2: Severe acute respiratory syndrome coronavirus type 2; COVID-19: Coronavirus disease 2019.