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World J Gastroenterol. Mar 14, 2021; 27(10): 928-938
Published online Mar 14, 2021. doi: 10.3748/wjg.v27.i10.928
Impact of the COVID-19 pandemic on liver donation and transplantation: A review of the literature
Riccardo De Carlis, Ivan Vella, Niccolò Incarbone, Leonardo Centonze, Vincenzo Buscemi, Andrea Lauterio, Luciano De Carlis
Riccardo De Carlis, Ivan Vella, Niccolò Incarbone, Leonardo Centonze, Vincenzo Buscemi, Andrea Lauterio, Luciano De Carlis, Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
Ivan Vella, Department of Surgical Sciences, University of Pavia, Pavia 27100, Italy
Niccolò Incarbone, Luciano De Carlis, Department of Medicine and Surgery, University of Milano-Bicocca, Milan 20126, Italy
Author contributions: De Carlis R performed data collection, interpreted data, and wrote the paper; Vella I, Incarbone N, Centonze L, Buscemi V, and Lauterio A performed data collection and reviewed the paper; De Carlis L critically reviewed the paper.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Riccardo De Carlis, MD, Doctor, Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore 3, Milan 20162, Italy. riccardo.decarlis@ospedaleniguarda.it
Received: January 11, 2021
Peer-review started: January 11, 2021
First decision: January 31, 2021
Revised: February 1, 2021
Accepted: February 25, 2021
Article in press: February 25, 2021
Published online: March 14, 2021
Processing time: 58 Days and 12.7 Hours
Abstract

The coronavirus disease 2019 (COVID-19) pandemic has upended healthcare systems worldwide and led to an inevitable decrease in liver transplantation (LT) activity. During the first pandemic wave, administrators and clinicians were obliged to make the difficult decision of whether to suspend or continue a life-saving procedure based on the scarce available evidence regarding the risk of transmission and mortality in immunosuppressed patients. Those centers where the activity continued or was heavily restricted were obliged to screen donors and recipients, design COVID-safe clinical pathways, and promote telehealth to prevent nosocomial transmission. Despite the ever-growing literature on COVID-19, the amount of high-quality literature on LT remains limited. This review will provide an updated view of the impact of the pandemic on LT programs worldwide. Donor and recipient screening, strategies for waitlist prioritization, and posttransplant risk of infection and mortality are discussed. Moreover, a particular focus is given to the possibility of donor-to-recipient transmission and immunosuppression management in COVID-positive recipients.

Keywords: Severe acute respiratory syndrome coronavirus type 2; Liver cirrhosis; Donor and recipient screening; Donor-to-recipient transmission; Immunosuppression; Resource allocation in transplantation

Core Tip: The coronavirus disease 2019 (COVID-19) pandemic has reduced liver transplantation (LT) activity worldwide at different rates in different regions. Testing for COVID-19 has been included in routine donor and recipient evaluations. LT recipients are likely at increased risk of infection, but COVID-related mortality appears to be comparable with the general population if corrected for concurrent risk factors. Immunosuppression could exert a protective effect against the most severe forms of COVID-19, and its complete withdrawal or reduction may not be useful. Transplant centers and administrators should allocate resources considering the actual burden of the infection, waitlist priority, risk of posttransplant infection, and mortality.