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World J Transplant. Sep 18, 2022; 12(9): 288-298
Published online Sep 18, 2022. doi: 10.5500/wjt.v12.i9.288
Liver transplantation during COVID-19: Adaptive measures with future significance
Argyrios Gyftopoulos, Ioannis A Ziogas, Martin I Montenovo
Argyrios Gyftopoulos, School of Medicine, National Kapodistrian University of Athens, Athens 14564, Greece
Ioannis A Ziogas, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
Martin I Montenovo, Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, United States
Author contributions: Gyftopoulos A performed the manuscript writing, designed the table and figures; Gyftopoulos A and Ziogas IA designed the figures; Ziogas IA aided in manuscript writing, statistical analysis; Ziogas IA and Montenovo MI revised the manuscript; Montenovo MI designed the study and provided the outline.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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:
Corresponding author: Martin I Montenovo, FACS, MD, Associate Professor, Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, 1313 21st Ave S, Nashville, TN 37232, United States.
Received: July 11, 2022
Peer-review started: July 11, 2022
First decision: August 4, 2022
Revised: August 8, 2022
Accepted: August 26, 2022
Article in press: August 26, 2022
Published online: September 18, 2022

Following the outbreak of coronavirus disease 2019 (COVID-19), a disease caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the field of liver transplantation, along with many other aspects of healthcare, underwent drastic changes. Despite an initial increase in waitlist mortality and a decrease in both living and deceased donor liver transplantation rates, through the implementation of a series of new measures, the transplant community was able to recover by the summer of 2020. Changes in waitlist prioritization, the gradual implementation of telehealth, and immunosuppressive regimen alterations amidst concerns regarding more severe disease in immunocompromised patients, were among the changes implemented in an attempt by the transplant community to adapt to the pandemic. More recently, with the advent of the Pfizer BNT162b2 vaccine, a powerful new preventative tool against infection, the pandemic is slowly beginning to subside. The pandemic has certainly brought transplant centers around the world to their limits. Despite the unspeakable tragedy, COVID-19 constitutes a valuable lesson for health systems to be more prepared for potential future health crises and for life-saving transplantation not to fall behind.

Keywords: Liver transplantation, COVID-19, SARS-CoV-2, Vaccine, Immunosuppression, Telehealth

Core Tip: Several articles in the bibliography report on the state of liver transplantation during coronavirus disease 2019 (COVID-19). To our knowledge, this is the first review to retrospectively investigate the various changes that occurred throughout the pandemic, but also recognize which interventions, and to what extent, are possibly going to help the transplant community improve beyond the end of COVID-19; in the event of a major health crisis in the future, transplant programs should be able to adapt even faster to the rapidly changing landscape, in order for life-saving transplantation not to fall behind.