Impact of the COVID-19 Pandemic on Patients with End Stage Liver Disease: One virus – a plethora of consequences

The COVID-19 pandemic has been a once in lifetime (hopefully) bitter experience for humanity recent times, and left an indelible mark on our lives. More than anything, it overwhelmed healthcare systems worldwide, led to tumultuous time medical Institutions, health professionals, more so patients who suffered from lack of care non-COVID related ailments too. Prominent among them were end stage liver disease waiting life-saving organ transplant, especially deceased donors, since the whole process identifying maintaining prospective donor, as well actually realising donor transplant (DDLT) was far-fetched dream during these times. In current issue JCEH, Jothimani et al. report retrospective single-center study evaluating impact clinical outcome waitlisted DDLT. During 2-year peak COVID (2020-21), less number listed quarter underwent Almost half unfortunately died without year 2021, with shorter death waitlist. These figures demonstrate stark reality resources outcomes under-served due resources, low donation rate. A competing risk survival model could also provide concrete idea significant wait list mortality such situation. Further, waitlist ratio would have worse States where hospitals sharing limited organs donated within that region. Several published studies showed infection associated morbidity cirrhosis, those decompensated cirrhosis1Iavarone M. D'Ambrosio R. Soria A. al.High rates 30-day cirrhosis COVID-19.J Hepatol. 2020; 73: 1063-1071https://doi.org/10.1016/j.jhep.2020.06.001Abstract Full Text PDF PubMed Scopus (213) Google Scholar, 2Moon A.M. Webb G.J. Aloman C. SARS-CoV-2 pre-existing chronic cirrhosis: Preliminary results international registry.J 705-708https://doi.org/10.1016/j.jhep.2020.05.013Abstract (181) 3Sarin S.K. Choudhury Lau G.K. al.Pre-existing is poor SARS CoV2 infection; APCOLIS Study (APASL Liver Injury Spectrum Study).Hepatol Int. 14: 690-700https://doi.org/10.1007/s12072-020-10072-8Crossref (161) 4Ioannou G.N. Liang P.S. Locke E. al.Cirrhosis Severe Acute Respiratory Syndrome Coronavirus 2 Infection US Veterans: Risk Infection, Hospitalization, Ventilation, Mortality.Hepatology. 2021; 74: 322-335https://doi.org/10.1002/hep.31649Crossref (49) Scholar. incidence ACLF (acute failure) significantly increased concurrent infection, higher mortality1Iavarone Scholar,2Moon Scholar,5Shalimar Elhence Vaishnav al.Poor Corona Virus Disease-19.Indian J Gastroenterol. 39: 285-291https://doi.org/10.1007/s12664-020-01074-3Crossref (33) 6Kumar P. Sharma Sulthana S.F. Kulkarni Rao P.N. Reddy D.N. 2-related Acute-on-chronic Failure.J Clin Exp 11: 404-406https://doi.org/10.1016/j.jceh.2020.12.007Abstract (12) 7Marjot T. Moon Cook J.A. al.Outcomes following disease: An registry study.J 567-577https://doi.org/10.1016/j.jhep.2020.09.024Abstract (275) fear acquiring before or after transplantation (LT) lead reduction LT numbers, remained at mortality8Polak W.G. Fondevila Karam V. al.Impact Europe: alert early survey European Intestine Transplantation Association Transplant Registry.Transpl 33: 1244-1252https://doi.org/10.1111/tri.13680Crossref (42) Also, did undergo sicker, MELD scores, hence, post operative higher. South India, region rate compared rest country, consequently DDLTs performed are Living (LDLT) by far predominant type India (85% LDLTs vs. 15% DDLTs). LDLT scenario affected pandemic, because addition recipient, healthy living donors perioperatively. Society Indian Organ NOTTO tried their best keep pace with, smoothen path professionals Institutes some extent, proposing (and updating) guidelines vaccination time9Gupta S. Sudhindran Saraf N. al.Liver Guidelines times.J 2022; 12: 180-185https://doi.org/10.1016/j.jceh.2021.08.012Abstract (4) 10Kute V.B. Agarwal Prakash J. al.NOTTO Vaccine Recipients.Indian Nephrol. 31: 89-91https://doi.org/10.4103/ijn.IJN_64_21Crossref 11Kute Meshram H.S. al.Update 2019 Recipients.Transplant Proc. 54: 1399-1404https://doi.org/10.1016/j.transproceed.2021.09.007Crossref (8) this period, recipients (in late post-LT period) generally driven age comorbidities, including diabetes, kidney disease, history malignancy12Belli L.S. Cortesi P.A. al.Protective Role Tacrolimus, Deleterious Age Comorbidities Recipients With Covid-19: Results From ELITA/ELTR Multi-center Study.Gastroenterology. 160: 1151-1163.e3https://doi.org/10.1053/j.gastro.2020.11.045Abstract (99) 13Rabiee Sadowski B. Adeniji Disease (COVID-19): U.S. Multicenter Experience.Hepatology. 72: 1900-1911https://doi.org/10.1002/hep.31574Crossref 14Becchetti Zambelli M.F. Pasulo L. al.COVID-19 recipient cohort.Gut. 69: 1832-1840https://doi.org/10.1136/gutjnl-2020-321923Crossref (102) 15Waisberg D.R. Abdala Nacif al.Coronavirus Early Postoperative Period Transplantation: Is Outcome Really So Positive?.Liver Transpl. 27: 1357-1359https://doi.org/10.1002/lt.25933Crossref (7) 16Jayant K. Reccia I. Virdis F. hospitalized recipients: systematic review meta-analysis.Clin Transplant. 35e14246https://doi.org/10.1111/ctr.14246Crossref It found while immunosuppression attenuate inflammatory response COVID-19, had potential increase virological injury secondary infections prolong viral shedding. Despite all concerns, encouraging note how centers managed continue activity, acceptable selected (albeit scores). proved be silver lining situations urgent transplants required, although involvement infection) not make easy17Malleeswaran Mohanka Yalakanti R.B. al.Living Donor Hepatectomy After Proven Infection: First Report 9 Cases 3 Centers.Transplantation. 105: e70-e71https://doi.org/10.1097/TP.0000000000003750Crossref Centers needed formulate follow only isolation protocols but surgical teams, entire team divided into sub-units working alternately if any member infected, other functional. short, restructuring program required activity restarted continued18Soin A.S. Choudhary N.S. Yadav al.Restructuring Living-Donor High-Volume Center Pandemic.J 418-423https://doi.org/10.1016/j.jceh.2020.09.009Abstract (18) Scholar,19Dhampalwar Saigal Recipients.Liver 26: 1665-1666https://doi.org/10.1002/lt.25909Crossref (17) initially too) many ways beyond just lower chance having thereof. pertinent publications focussed occurrence intake drugs vaccines used prevention infection20Kumar Favipiravir-induced Patients 2019.J Transl 9: 276-278https://doi.org/10.14218/JCTH.2021.00011Crossref Scholar,21Kulkarni A.V. Anders Nazal Ridruejo Efe severe acute inactivated vaccination.J 2023; 78: e60-e61https://doi.org/10.1016/j.jhep.2022.10.026Abstract (2) Scholar; cholangiopathy requiring even salvage cases22Rela Rajakannu Veerankutty F.H. Vij Rammohan auxiliary respiratory infection.Am 22: 3143-3145https://doi.org/10.1111/ajt.17165Abstract (5) collateral diseases (even infection)23Vashishtha Bhardwaj Diwaker M.K. Sarin Collateral Impact Diseases Second Wave: Retrospective Cohort Study.Cureus. 14e25542https://doi.org/10.7759/cureus.25542Crossref forced doctors Institutions experiencing true sense helplessness hopelessness Thousands fighting adequate. Consequently, one cohort most, inability seek support restricted travel, priority availability emergency measures endoscopy, interventional procedures course transplants. wake-up call healtcare sector us strengthen protocols, policies infrastructure tackle unforeseen catastrophes. lesson too, most difficult selfless efforts (individual work) coupled system, help accomplish seemingly impossible task saving lives demonstrated India. None.