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World J Transplant. Nov 18, 2022; 12(11): 347-358
Published online Nov 18, 2022. doi: 10.5500/wjt.v12.i11.347
Challenges in liver transplantation in the context of a major pandemic
Eleni Theocharidou, Danielle Adebayo
Eleni Theocharidou, 2nd Department of Internal Medicine, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
Danielle Adebayo, Department of Gastroenterology and Hepatology, Royal Berkshire NHS Foundation Trust, London Road, Reading, RG1 5AN, United Kingdom
Author contributions: Theocharidou E reviewed the literature, wrote the paper and approved the final draft. Adebayo D reviewed the literature, critically revised the paper and approved the final draft.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Eleni Theocharidou, PhD, 2nd Department of Internal Medicine, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece. elenit@auth.gr
Received: June 9, 2022
Peer-review started: June 9, 2022
First decision: July 13, 2022
Revised: August 27, 2022
Accepted: September 22, 2022
Article in press: September 22, 2022
Published online: November 18, 2022
Abstract

Coronavirus disease-2019 (COVID-19) has led to a temporary suspension of liver transplant activity across the world and the remodeling of care for patients on the waiting list and transplant recipients with the increasing use of remote consultations. Emerging evidence shows that patients with more advanced liver disease are at increased risk of severe COVID-19 and death, whereas transplant recipients have similar risk with the general population which is mainly driven by age and metabolic comorbidities. Tacrolimus immunosuppression might have a protective role in the post-transplant population. Vaccines that have become rapidly available seem to be safe in liver patients, but the antibody response in transplant patients is likely suboptimal. Most transplant centers were gradually able to resume activity soon after the onset of the pandemic and after modifying their pathways to optimize safety for patients and workforce. Preliminary evidence regarding utilizing grafts from positive donors and/or transplanting recently recovered or infected recipients under certain circumstances is encouraging and may allow offering life-saving transplant to patients at the greatest need. This review summarizes the currently available data on liver transplantation in the context of a major pandemic and discusses areas of uncertainty and future challenges. Lessons learnt from the COVID-19 pandemic might provide invaluable guidance for future pandemics.

Keywords: COVID-19, Pandemic, Liver transplantation, Chronic liver disease, Immunosuppression, Vaccines

Core Tip: Coronavirus disease-2019 pandemic posed unprecedented challenges in terms of managing patients with advanced liver disease remotely, offering transplant for highly selected patients, managing immunosuppression, treating infected patients with chronic liver disease, transplanting infected patients, and utilizing grafts from infected donors. The transplant community responded rapidly to these challenges and many centers were able to resume activity soon after the first wave of the pandemic. Emerging data help shed light on areas of uncertainty and provide guidance for future challenges.