Liver graft dysfunction caused by viral COVID-19 infection, case report

Abstract

In patients with the viral infection COVID-19, hepatocellular lesions could be found in 14-53% of cases, rarely with the development of acute hepatitis. Patients with COVID-19 and cytolysis >5 N have an increased risk of death with the development of infections, pre-existing immune dysfunction. Material and methods: Female 52 years old, with liver cirrhosis (LC) HDV, MELD Na 21, Living donor liver transplantation (LDLT). On day 14 post-LT develops SARS CoV2 viral infection. Results: A significant increase in liver enzymes from day 14 post LT, diarrhea (Ag. Cl. Difficile - positive, initiated treatment resulted). The evolution of the aggravating disease continues with marked cytolysis, the increase of inflammatory indices, with the development of hilo-basal pulmonary infiltration with pleural effusion on the right. Treatment performed according to the cultures received, immunosuppression (tacrolimus) maintained at a suboptimal level. Saturation kept during the infection period. Stagnant liver enzymes, gradual decrease from day 27. After 39 days from onset, clinical-biochemical status improved, tacrolimus adjusted according to protocol, MMF resumed. Conclusions: The factors that influenced the evolution of the liver transplant: pre-existing liver disease, hiponatriemia, SARS COV 2 viral infection, C. difficile infection, vascular hemodynamic disorders, biliary complications, prolonged duration in the intensive care unit, long hospital stay. The immunosuppressive treatment associated with SARS COV 2 infection needs to be monitored, balanced according to the clinical-biological state of the patient, taking into account the dose, and type of immunosuppression, the post-LT period.