Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 27, 2020; 12(10): 870-879
Published online Oct 27, 2020. doi: 10.4254/wjh.v12.i10.870
Severe COVID-19 after liver transplantation, surviving the pitfalls of learning on-the-go: Three case reports
Felipe Alconchel, Pedro A Cascales-Campos, Jose A Pons, María Martínez, Josefa Valiente-Campos, Urszula Gajownik, María L Ortiz, Laura Martínez-Alarcón, Pascual Parrilla, Ricardo Robles, Francisco Sánchez-Bueno, Santiago Moreno, Pablo Ramírez
Felipe Alconchel, Pedro A Cascales-Campos, Josefa Valiente-Campos, Laura Martínez-Alarcón, Pascual Parrilla, Ricardo Robles, Francisco Sánchez-Bueno, Pablo Ramírez, Department of Surgery and Organ Transplantation, Virgen de la Arrixaca University Hospital, Murcia 30120, Spain
Felipe Alconchel, Pedro A Cascales-Campos, Jose A Pons, María Martínez, Josefa Valiente-Campos, Urszula Gajownik, María L Ortiz, Laura Martínez-Alarcón, Pascual Parrilla, Ricardo Robles, Francisco Sánchez-Bueno, Pablo Ramírez, Department of Digestive, Endocrine and Abdominal Surgery and Transplantation, Biomedical Research Institute of Murcia (IMIB-Virgen de la Arrixaca), Murcia 30120, Spain
Jose A Pons, Urszula Gajownik, María L Ortiz, Department of Hepatology, Virgen de la Arrixaca University Hospital, Murcia 30120, Spain
María Martínez, Department of Intensive Care Unit, Virgen de la Arrixaca University Hospital, Murcia 30120, Spain
Santiago Moreno, Department of Infectious Diseases, Ramon y Cajal Hospital, Madrid 28034, Spain
Author contributions: Alconchel F, Cascales-Campos PA and Ramírez P designed this article; Alconchel F, Pons JA, Martínez M, Valiente-Campos J, Martínez-Alarcón L, Ortiz ML and Gajownik U collected a substantial portion of data; Alconchel F, Cascales-Campos PA, Parrilla P, Robles R, Sánchez-Bueno F, Moreno S and Ramírez P analysised and interpreted of data; Alconchel F, Cascales-Campos PA and Ramírez P drafted of the manuscript; Parrilla P, Robles R, Sánchez-Bueno F, Moreno S and Ramírez P revised of the manuscript's important intellectual content critically; Parrilla P and Ramírez P supervised; Alconchel F, Cascales-Campos PA, Pons JA, Martínez M, Valiente-Campos J, Gajownik U, Ortiz ML, Parrila P, Robles R, Sánchez-Bueno F, Moreno S and Ramírez approved of the final version to be published.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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: Felipe Alconchel, MD, PhD, Doctor, Surgeon, Department of Surgery and Organ Transplantation, Virgen de la Arrixaca University Hospital, Ctra. Madrid-Cartagena s/n, Murcia 30120, Spain. alconchelgago@gmail.com
Received: July 29, 2020
Peer-review started: July 29, 2020
First decision: September 12, 2020
Revised: September 12, 2020
Accepted: September 22, 2020
Article in press: September 22, 2020
Published online: October 27, 2020
Abstract
BACKGROUND

The novel coronavirus 2019 (COVID-19) pandemic has dramatically transformed the care of the liver transplant patient. In patients who are immunosuppressed and with multiple comorbidities, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with increased severity and mortality. The main objective of this report is to communicate our experience in the therapeutic management of SARS-CoV-2 infection in 3 liver transplant patients. Secondly, we stress the management and investigation of the contagious spreading into a liver transplant ward.

CASE SUMMARY

The patients were two women (aged 61 years and 62 years) and one man (aged 68 years), all of them having recently received a liver transplant. All three patients required intensive care unit admission and invasive mechanical ventilation. Two of them progressed severely until death. The other one, who received tocilizumab, had a good recovery. In the outbreak, the wife of one of the patients and four healthcare professionals involved in their care were also infected.

CONCLUSION

We illustrate in detail the evolution of a nosocomial COVID-19 outbreak in a liver transplant ward. We believe that these findings will contribute to a better understanding of the natural history of the disease and will improve the treatment of the liver transplant patient with COVID-19.

Keywords: Liver transplantation, COVID-19, SARS-CoV-2, Cross infection, Nosocomial infection, Case report

Core Tip: In patients who are immunosuppressed and with multiple comorbidities, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with increased severity and mortality. We report our experience in the therapeutic management of SARS-CoV-2 infection in 3 liver transplant patients and stress the management and investigation of a contagious spreading into a liver transplant ward.