Liver Transplant in the times of COVID-19

Amidst the COVID-19 pandemic, our team at the Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta- The Medicity, Gurugram, has been working relentlessly for the best care of patients with liver diseases and COVID-19. As Transplants recipients, many of you may have queries and concerns about how this infection can impact your lives and those of people around you.

What is COVID-19 infection and how does it spread?
COVID-19 is a Corona virus disease which causes respiratory infections ranging from the common cold to more severe diseases like pneumonia or acute respiratory distress syndrome. The COVID -19 virus spreads primarily through droplets of saliva or discharge from nose when an infected person coughs or sneezes. Contact from an infected surface via the hand to nose, mouth and eyes leads to spread of this virus.

What are the symptoms of COVID-19?
Symptoms are very similar to other seasonal respiratory diseases like cold and influenza to ‘the flu’. They can include fever, cough, runny nose and difficulty breathing. Some patients may present with altered smell, taste, diarrhea or malaise. Few may present with pneumonia and acute respiratory distress syndrome.
Breathing problems like suffocation or fall in oxygen saturation on pulse oximeter suggests suspicion of COVID 19 pneumonia.

Dos and Don’ts for Liver transplant recipients in this pandemic!
Avoid close contact with anyone who is sick.
Avoid touching your eyes, nose and mouth.
During cough or sneezing, practice proper etiquettes by covering nose with tissue or handkerchief or blow and then wash your hands.
Keep house clean.
Wash hands frequently with soap and water for at least 20-30 seconds before and after eating and other routine activities. If soap is not available, then use alcohol based sanitizer.
Avoid crowded places like restaurants, bars, sports venues, etc.
If COVID 19 is in your community, stay home and work from home as much as possible.
No changes in diet. Every effort should be made to properly clean all fruits and vegetables and eat well cooked food.

Are transplant patients at higher risk for COVID 19?
Yes. Transplant patients are immunocompromised because of the immunosuppression medicines. There is no need to reduce or decrease this immunosuppressive medicines as it can lead to other problems like liver graft rejection. As the COVID 19 risk is higher in transplant patients, the precautions mentioned above should be strictly followed. Amidst COVID-19 pandemic, Telemedicine has proved to be a breakthrough with increasing acceptance from patients. There is this transition from traditional hospital visits to virtual visits by video calls, on Medanta eClinic platform. We now do most of our follow up clinics through Telemedicine. This way the transplant patients can be at home and under medical supervision at the same time, thus reducing the risk of COVID-19 infection.

It is anticipated that transplant recipients, being immunocompromised, after contracting COVID-19 infection have greater viral burdens and shedding resulting in greater infectivity and potential spread to other individuals. Our team has the highest experience in treating COVID-19 infections in Liver transplant recipients and we have also published our experience in top journals. The treatment usually includes antivirals and antibiotics. Admissions to hospitals are advised only in mild to severe cases. We have also given plasma therapy to many of our patients with ambiguous results. Medanta Hospital has recently been appreciated for providing the best care for COVID-19 in India.

I am suffering from liver disease. My doctors have advised me a Liver Transplant. What should I do?
Our team has performed the maximum number of transplants in India in the COVID era. The reasons for our success have been the repeated screening tests for COVID-19 for both donor and recipients as well as the attendants and healthcare workers. We have been able to separate the COVID patients from normal patients and hence been able to prevent the spread of virus. We have also transplanted patients with liver diseases after recovery from CPVID-19, and have similar outcomes as non-covid transplant recipients.

I am a prospective liver Donor and What are my chances of contracting COVID-19 after transplant?
For Liver Donors, the risk of contracting COVID-19 infection will be the same as that of general population. For COVID recovered prospective liver donors, we wait for at least 3 weeks after they become COVID RT PCR negative, before they can safely donate a part of their Liver. The chances of transmission of COVID-19 from donors to recipients is not yet documented.