Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2021; 13(12): 2161-2167
Published online Dec 27, 2021. doi: 10.4254/wjh.v13.i12.2161
Managing liver transplantation during the COVID-19 pandemic: A survey among transplant centers in the Southeast United States
Adalberto Jose Gonzalez, Nikhil Kapila, Emmanuel Thomas, Antonio Pinna, Andreas Tzakis, Xaralambos Bobby Zervos
Adalberto Jose Gonzalez, Department of Gastroenterology, Cleveland Clinic Florida, Weston, FL 33324, United States
Nikhil Kapila, Antonio Pinna, Andreas Tzakis, Xaralambos Bobby Zervos, Department of Transplant, Cleveland Clinic Florida, Weston, FL 33331, United States
Emmanuel Thomas, Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, Miami, FL 33136, United States
Emmanuel Thomas, Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, United States
Author contributions: Gonzalez AJ and Kapila N wrote the initial manuscript; Thomas E, Pinna A, Tzakis A, and Zervos XB devised the study design and questionnaire and edited the manuscript.
Institutional review board statement: The study did not require approval by the Cleveland Clinic Florida IRB as it was a survey study and did not involve patient data.
Informed consent statement: Informed consent was not needed as no patients were enrolled in this study.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: Data is available upon reasonable request.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement checklist of items.
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: Xaralambos Bobby Zervos, DO, Doctor, Department of Transplant, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, United States. zervosx@ccf.org
Received: March 26, 2021
Peer-review started: March 26, 2021
First decision: June 15, 2021
Revised: June 29, 2021
Accepted: October 17, 2021
Article in press: October 17, 2021
Published online: December 27, 2021

The coronavirus disease-2019 (COVID-19) pandemic has had a profound worldwide impact. Indeed, it has led to a vast decrease in organ transplantation, including liver transplants (LT). There is little data regarding adjustments made by LT centers as a response to the COVID-19 pandemic.


To assess the experience of LT centers in the United States during the pandemic.


We performed an observational survey study from May 11, 2020 to June 5, 2020. We sent out a 13 question survey to 15 LT centers across the southeastern United States.


Eleven LT centers responded to the survey. We found that (11/11) 100% of transplant centers made adjustments because of the COVID-19 pandemic. At least 50% of transplant centers had at least one transplant recipient infected with COVID-19. To adjust, greater than 50% of centers performed fewer LT, 100% of patients were tested for COVID-19, and most centers implemented a virtual platform.


The COVID-19 pandemic greatly affected liver transplantation in the southeastern United States. It was evident that a concerted effort was made by LT centers to protect their patients and employees from COVID-19 but also to continue the life-saving procedure of LT in this sick patient population. Further studies are needed to assess how LT centers around the world managed the pandemic in order to learn strategies to continue life-saving procedures in this patient population.

Keywords: COVID-19, Liver transplantation, Survey, Telemedicine, Immunosuppression, Solid organ transplantation

Core Tip: The coronavirus disease-2019 (COVID-19) pandemic tremendously affected solid organ transplantation around the world, but little information has been published regarding adaptation from transplant centers. We performed a survey study of 11 Liver transplant (LT) centers in the southeastern United States. 100% of transplant centers made adjustments. COVID-19 testing of transplant candidates, virtual clinic visits, and use of remote allocation of staff were among the most commonly utilized strategies. These strategies can be advantageously used in LT centers in the future. We recommend contingency plans be in place in case of future unprecedented states of emergency.