Bilateral polysegmentary pneumonia caused by SARS-CoV-2 in a transplanted liver recipient

Background. In December 2019, the humanity met a previously unknown infectious disease (COVID-19) caused by a new coronavirus called SARS-CoV-2. An important role in the treatment of COVID-19 belongs to anti-inflammatory and immunosuppressive drugs. In this regard, the cases of the disease in patients undergoing long-term immunosuppressive therapy, for example, organ transplant recipients, are of particular interest. We present our clinical observation of COVID-19 in a liver recipient patient, which, apparently, is the first in the Russian Federation. Clinical case description A 54-year-old man, 10 years ago at the A.I. Burnazyan Center underwent transplantation of the right lobe of the liver after resection of hepatocellular carcinoma, T2N0M0, and due to liver cirrhosis as a result of НСV hepatitis. At the time of hospitalization, he had been constantly receiving immunosuppressive monotherapy with everolimus. The patient was transferred to an infectious disease hospital due to a positive PCR test for SARS-CoV-2 RNA. No signs of respiratory failure were found upon admission. Subsequently, a mild course of COVID-19 was observed, without signs of an acute inflammatory reaction, with normal CRP values and a slight increase of ferritin. 7 days after the treatment, the patient was discharged for outpatient observation. Conclusion. This clinical case is of interest not only by the success of the treatment of the new coronavirus infection COVID-19 in an immunocompromised patient a recipient of a liver transplant, but also by the fact that the disease manifested itself primarily as a transient increase in hepatic aminotransferases, which can be attributed to the gastrointestinal manifestations of COVID-19.

Clinical Impacts and Outcomes With Possible Donor-Derived Infection in Infected Donor Liver Transplantation: A Single-Center Retrospective Study in China

Background Information on possible donor-derived transmission events in China is limited. We evaluated the impacts of liver transplantation from infected deceased-donors, analyzed possible donor-derived bacterial or fungal infection events in recipients, and evaluated the etiologic agents’ characteristics and cases outcomes. Methods A single-center observational study was performed from January 2015 to March 2017 to retrospectively collect data from deceased-donors diagnosed with infection. Clinical data were recorded for each culture-positive donor and the matched liver recipient. The microorganisms were isolated and identified, and antibiotic sensitivity testing was performed. The pathogens distribution and incidence of possible donor-derived infection (P-DDI) events were analyzed and evaluated. Results Information from 211 donors was collected. Of these, 82 donors were infected and classified as the donation after brain death category. Overall, 149 and 138 pathogens were isolated from 82 infected donors and 82 matched liver recipients, respectively. Gram-positive bacteria, Gram-negative bacteria, and fungi accounted for 42.3% (63 of 149), 46.3% (69 of 149), and 11.4% (17 of 149) of pathogens in infected donors. The incidence of multidrug-resistant bacteria was high and Acinetobacter baumannii was the most concerning species. Infections occurred within the first 2 weeks after liver transplantation with an organ from an infected donor. Compared with the noninfection recipient group, the infection recipient group experienced a longer mechanical ventilation time (P = .004) and intensive care unit stay (P = .003), a higher incidence of renal dysfunction (P = .026) and renal replacement therapy (P = .001), and higher hospital mortality (P = .015). Possible donor-derived infection was observed in 14.6% of cases. Recipients with acute-on-chronic liver failure were more prone to have P-DDI than recipients with other diseases (P = .007; odds ratio = 0.114; 95% confidence interval, .025–.529). Conclusions When a liver recipient receives a graft from an infected deceased-donor, the postoperative incidence of infection is high and the infection interval is short. In addition, when a possible donor-derived, drug-resistant bacterial infection occurs, recipients may have serious complications and poor outcomes.

Diagnostic Effectiveness of Transforming Growth Factor Beta 1 in Assessing the Risk of Developing Graft Dysfunction in Liver Recipient Children

The problem of non-invasive monitoring of the liver condition is particularly relevant in liver transplantation among young children. Transforming growth factor beta 1 (TGF-β1) is a pleiotropic cytokine with a profibrogenic and immunosuppressive effect that can have a definite effect on the liver transplant functioning.Aim. To determine the diagnostic efficacy of TGF-β1 in blood when assessing the risk of developing graft dysfunction in liver recipient children.Materials and methods.95 children aged 3 to 73 months with liver cirrhosis of various etiologies were surveyed. All the patients underwent liver transplantation (LT) from a living related donor. The TGF-β1 concentration in plasma was determined using ELISA on average 3 ± 2 days prior to liver transplantation and in the early post-transplant period.Results.The level of TGF-β1 in the blood of children with liver cirrhosis was lower than in healthy children (p = 0.001). LT was accompanied by an increase in the TGF-β1 content in the blood of recipients (p = 0.001). The incidence of graft dysfunction in the early postoperative period correlated with the pre-transplantation level of TGF-β1 (r = 0.40, p = 0.00), which was lower in recipients with developed graft dysfunction than in patients without dysfunction (1.7 ± 1.3 ng/ml versus 6.7 ± 5.3 ng/ml, p = 0.001). The analysis of the test diagnostic efficiency showed that the area under the ROC curve (AUC) was 0.85 ± 0.05, 95 % CI 0.75–0.94, the sensitivity of the method was 83 %, its specificity was 77 %. When the marker value was less than the threshold (2.2 ng/ml), the relative risk of developing graft dysfunction was 11.4 ± 0.7, 95 % CI 2.7-48.7. The accuracy of the method, the positive predictive value and the negative predictive value of the results were 78, 83 and 77 %, respectively.Conclusion.The level of TGF-β1 in the blood of liver recipient children before transplantation below 2.2 ng/ml increases the risk of developing graft dysfunction in the early postoperative period 11-fold. Measuring the TGF-β1 level in the blood prior to liver transplantation makes it possible to identify recipients with 85 % chance of developing a graft dysfunction.