- Any patients forced to be in the ICU should take special precautions as to not become infected with COVID-19
- All recipient patients are extremely high risk and their vitals should be monitored very closely for any and all signs of complication
- Patient exchange between hospitals may be necessary to house ICU transplant patients if proper care cannot be administered at the primary facility
- All patients and staff within the ICU should use different paths with non-COVID-19 cases in order to minimize possible risk of infection


Ohio State University, Columbus

- This paper provides an in depth look regarding some of the updated practices relating to liver transplant during the COVID-19 era
- This paper seeks to cover a myriad of topics regarding all parts of the procedure including some of the surgical considerations during the COVID-19 era, donor risks and care during the pandemic, various precautions during the preparation of patients for liver transplantation, postoperative care procedures for transplant recipients, and ICU care for liver transplant patients during COVID-19


Liver transplantation in the era of COVID-19

El Kassas, M., Alboraie, M., Al Balakosy, A., Abdeen, N., Afify, S., Abdalgaber, M., Sherief, A. F., Madkour, A., Abdellah Ahmed, M., Eltabbakh, M., Salaheldin, M., & Wifi, M.-N. (2020). Liver transplantation in the era of COVID-19. Arab Journal of Gastroenterology, 21(2), 69–75. https://doi.org/10.1016/j.ajg.2020.04.019\

URL: https://bit.ly/2OlijCG


- All staff present for procedures are more than ever required to be covered in PPE
- Many outpatient and elective procedures during the COVID-19 era should be limited as to decrease infection in hospital as much as possible
- All procedures associated with aerosol production including suction, endotracheal intubation, and advanced endoscopic treatments should be put on hold as they present high possibility for infection
- Outpatient and elective procedures are also being put on hiatus or cancelled in order to limit healthcare worker infection as the possibility during one of these procedures is high
- In order to determine whether a procedure is elective or not, rigorous evaluation should be performed along with regular COVID-19 screening


Surgical Considerations During the COVID-19 Era

- While there is inherent risk for infection during any surgical procedure, liver donation could be performed during the COVID-19 era as long as the donor has been confirmed negative for the virus
- Two types of liver donation procedures may be utilized at this time, standard procedures using whole liver grafts DDLT and the use of the LDLT procedure using cadaveric organs
- It would be best practice to maintain as little contact with all donors as much as possible during the entirety of the donation procedure as they are at high risk to become infected
- All donors should be aimed to be discharged as soon as possible after donation


Donor Risks and Care During the COVID-19 Pandemic

- IT has become more important than ever to be extremely cautious when it comes to beginning the liver transplantation procedure
- Streptococcal pneumonia and influenza vaccines are now strongly recommended prior to transplantation
- Both donors and recipients should receive COVID-19 testing prior to their specific procedures
- CT scans of the chest should be highly considered as well
- Any members of the transplant team that may have COVID-19 symptoms should be quarantined immediately to limit risk


Precautions for Preparation of Patients Before Liver Transplantation

- All liver transplant recipients should be moved to ward after surgery where there is complete separation from COVID-19 admission
- All imaging, blood tests, and medical rounds should be limited in post-op patients to limit chance of infection
- Any required in-person outpatient should be conducted in facilities far from areas of high COVID-19 risks


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