Transplant Infectious Disease, Год журнала: 2023, Номер 25(5)
Опубликована: Сен. 7, 2023
Every year, thousands of patients in need liver transplantation (LT) die while waiting for lifesaving surgery, largely due to a shortage donor organs. It is therefore an imperative find new approaches expand the organ pool, including use donors with active infections. While each pathogen and be transplanted create unique scenarios requiring careful assessment risks benefits recipient, there ever-growing list infections shown safe. In this context, utilization grafts from infected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was considered relatively early disease 2019 (COVID-19) pandemic but initially recommended against by most societies serious concerns related risk viral transmission recipient medical teams, lack effective antiviral treatments about quality.1 Particular LT, SARS-CoV-2 complicated studies showing high prevalence injury among COVID-19 presence virus polymerase chain reaction histological changes autopsy studies.2, 3 Among chronic disease, also increased on failure as well cases COVID-19-associated cholangiopathy, who required LT.4, 5 Finally, were unknown extra-hepatic manifestations transmission, thrombotic complications, LT recipients.6 Despite these concerns, last few years has been progressively widespread (for other than lungs intestines), reassuring data accumulating regarding short-term outcomes.7, 8 However, remain significant knowledge gaps long-term safety recent or infection. issue Transplant Infectious Disease, Martini et al. describe one-year post-LT outcomes 25 received recently acutely donors, compared control group 258 uninfected donors.9 Their study protocol included information not available previous studies, both imaging histopathologic at time follow-up. Patients population underwent cholangiography months magnetic resonance cholangiopancreatography after least 6 post-LT. Liver biopsy obtained then per 12 Additional biopsies performed otherwise indicated standard clinical care. All except one, had positive testing within weeks prior donation, indicating recent/acute infection interestingly, only 1 tested ribonucleic acid biopsy. recipients IgG anti-SARS-CoV-2 roughly half history Overall, remarkably favorable outcomes. The one two-year survival 88.5% no evidence findings COVID-19-related any recipient. Perhaps notable finding rate hepatic artery thrombosis (HAT) (12% vs. 2.7%, p = .048), complications HAT two re-transplantation ischemic cholangiopathy. this, overall re-LT death significantly different between groups. Although rare, described complication general should larger context events COVID-19.6, 10 it presumed that 48% graft personal COVID-19, potentially leading risk, timing reported. To assess potential contributor, would have important know how many COVID-19. There are several strengths study, follow-up protocolized confirmatory demonstrating consistent hepatitis granular previously available. Some limitations include single center nature which does account some inherent variability exists institutions, fact took place over 2-year span during pandemic, through changing therapies varying measures prevention, vaccines. consider inadvertent selection bias. Model End-Stage Disease scores did differ groups, more hepatocellular carcinoma group. This raises possibility non-random process candidates receive detailed important. Lastly, additional themselves report. For example, acuity severity provided. four pneumonia, known if even (i.e., distress syndrome) seven (28%) symptoms. Further, measure quality, mean index 1.9 comparison. Upon further inspection, clear what driving rates steatosis Donation Circulatory Death organs low. addition, peak enzymes possible A comparison groups could helped better articulate its impact post-transplant risk. however, supports existing literature minimal short- using Current antimicrobial susceptibility test guidance states acceptable end-organ dysfunction.11 Given now endemic SARS-CoV-2, transplant community will continue encounter mostly asymptomatic incidentally diagnosed, identify factors associated indirect recipients. Specific needed clarify vascular benefit prophylactic anticoagulation individuals. end, such colleagues critical closing gap optimizing Meaghan M. Phipps: conceptualization; writing—original draft; writing—review & editing. Elizabeth C. Verna: editing authors declare conflict interest. support corresponding author upon reasonable request.
Язык: Английский
