Perioperative Analysis of Patients Undergoing Liver Transplantation at the Hospital de Clínicas da Unicamp in the Context of SARS-Cov-2 Pandemic
Keywords:
COVID 19, Chest CT, Liver Transplant, T-PCRAbstract
Introduction: SARS-CoV-2 began in 2020 and caused important changes in the number of transplants performed in hospitals and in the protocols for admitting candidates to perform the procedure. The Brazilian Association of Organ Transplantation (ABTO) recommends not performing transplants from donors with active COVID-19 infection, positive test results or with Severe Acute Respiratory Syndrome. The hepatic repercussions related to COVID-19 are presented in some reports in the medical literature. Liver changes resulting from other corona viruses such as SARS-CoV and MERS-CoV are well documented. The Hospital de Clínicas of the State University of Campinas is a tertiary center that performs solid organ transplants. Objectives: To carry out a perioperative, retrospective, descriptive analysis of liver transplants in the context of the SARS-CoV-2 pandemic carried out at the Hospital das Clínicas of the State University of Campinas from March 2020 to July 2021. Materials and Methods: Retrospective, descriptive, longitudinal cohort study based on the review of medical records of patients undergoing liver transplantation in the context of the SARS-CoV-2 pandemic from March 2020 to July 2021 at the clinical hospital of the State University of Campinas. Results: Retrospective analysis was performed on 57 patients in the period. Only 1 patient needed to be excluded because he was under 18 years old. Of the 56 patients, 52 underwent RT-PCR laboratory testing and chest tomography (CT). Of these 52 patients, only 2 tested positive, one pre-transplant (TX) and one post-operatively (post-op). Regarding chest CT scans, none of them showed typical changes for COVID pre-TX, in the postop 4 patients presented typical chest CT scans. The average age was 55.86 years. The mortality rate was 38% and no deaths were attributed to COVID 19. The average MELD-Na scale was 20.94. Conclusion: The present study carried out at the Hospital de Clínicas da Unicamp analyzed the clinical, laboratory and radiological association to better elucidate the variables determined by COVID-19 in its diagnosis and in-hospital management. It is concluded that the SARS-CoV-2 pandemic had an impact on the routine of liver transplantation worldwide and on the service in which the study was carried out.
Downloads
References
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020;395(10223):497-506, https://doi.org/10.1016/S0140-6736(20)30183-5.
Danziger-Isakov L, Blumberg EA, Manuel O, Sester M. Impact of COVID-19 in solid organ transplant recipients. Am J of Transplant. 2021;21(3):925-37. https://doi.org/10.1111/ajt.16449
Raja MA, Mendoza MA, Villavicencio A, Anjan S, Reynolds JM, Kittipibul V., et al. COVID-19 in solid organ transplant recipients: A systematic review and meta-analysis of current literature. Transplant Rev. 2021;35(1):100588. https://doi.org/10.1016/j.trre.2020.100588
Nacif LS, Zanini LY, Waisberg DR, Pinheiro RS, Galvão F, Andraus W, et al. COVID- 19 in solid organ transplantation patients: A systematic review. Clinics. 2020;75:e1983. https://doi.org/10.6061/clinics/2020/e1983
Gumber L, Gumber A. COVID-19 and ‘lockdown’ in organ transplantation in the UK, Public Health. 2020; 185:55-6. https://doi.org/10.1016/j.puhe.2020.06.017
Cholankeril G, Podboy A, Alshuwaykh OS, Kim D, Kanwal F, Esquivel C, et al. Early impact of COVID-19 on solid organ transplantation in the United States. Transplantation. 2020;104(11):2221-4. https://doi.org/10.1097/TP.0000000000003391
Comissão de Infecção em Transplantes, Associação Brasileira de Transplantes de Órgãos. Novo Coronavírus – SARS-CoV-2 Recomendações no Cenário de Transplantes de Órgãos Sólidos. Atualização 16/03/2020. [acessed on: 16/03/2020] http://www.abto.org.br/abtov03/Upload/file/Coronavi%CC%81rus%20%20Recomendac%CC%A7o%CC%83es.pdf
Comissão de Infecção em Transplantes, Associação Brasileira de Transplantes de Órgãos. Novo Coronavírus – SARSCoV-2 Orientações para Manejo do Candidato à Transplante de Transplantes de Órgãos Sólidos durante a Pandemia de Covid-19. Atualização 25/08/2020. https://site.abto.org.br/wp-content/uploads/2020/05/orientacoes_coint.pdf Acessed on:[11/10/2023]
Kumar-M P, Mishra S, Jha DK, Shukla J, Choudhury A, Mohindra R, et al. Coronavirus disease (COVID-19) and the liver: a comprehensive systematic review and meta-analysis. Hepatol Int. 2020; 14:711-22. https://doi.org/10.1007/s12072-020-10071-9
Yao X-H, Luo T, Shi Y, He Z-C, Tang R, Zhang P-P, et al. A cohort autopsy study defines COVID-19 systemic pathogenesis. Cell Res. 2021; 31:836-46. https://doi.org/10.1038/s41422-021-00523-8
Brandão SCS, Godoi ETAM, Ramos JOX, Melo LMMP, Sarinho ESC. COVID-19 grave: entenda o papel da imunidade, do endotélio e da coagulação na prática clínica. J Vasc Bras. 2020;19:e20200131. https://doi.org/10.1590/1677-5449.200131
Kanmaniraja D, Kurian J, Holder J, Gunther MS, Chernyak V, Hsu K, et al. Review of COVID-19, part 1: Abdominal manifestations in adults and multisystem inflammatory syndrome in children. Clinical Imaging. 2021; 80:88-110. https://doi.org/10.1016/j.clinimag.2021.06.025
Guan GW, Gao L, Wang JW, et al. Exploring the mechanism of liver enzyme abnormalities in patients with novel coronavirus-infected pneumonia. Zhonghua Gan Zang Bing Za Zhi. 2020;28:100-6. https://doi.org/10.3760/cma.j.issn.1007-3418.2020.02.002
Lucilius C. No Setembro Verde, Hospital de Clínicas comemora 30 anos do 1º transplante de fígado. Hospital de Clínicas da Unicamp, 2021. https://hc.unicamp.br/newsite_noticia_240_no-setembro-verde-hospital-de-clinicas-comemora-30-anosdo-1o-transplante-de-figado/ Acessed on [13/10/2021]
Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH, Chung M, et al. Radiological Society of North America Expert Consensus Document on Reporting Chest CT Findings Related to COVID-19: Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiol: Cardiothorac Imaging. 2020;2(2):e200152. https://doi.org/10.1148/ryct.2020200152
Baganate F, Beal EW, Tumin D, Azoulay D, Mumtaz K, Black SM, et al. Early mortality after liver transplantation: Defining the course and the cause. Surgery. 2018;164(4):694-704. https://doi.org/10.1016/j.surg.2018.04.039
Huang P, Liu T, Huang L, Liu H, Lei M, Xu W, et al. Use of Chest CT in Combination with Negative RT-PCR Assay for the 2019 Novel Coronavirus but High Clinical Suspicion. Radiology. 2020;295(1):22-3. https://doi.org/10.1148/radiol.2020200330
Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for Typical Coronavirus Disease 2019 (COVID-19) Pneumonia: Relationship to Negative RT-PCR Testing. Radiology. 2020;296(2):E41-E45. https://doi.org/10.1148/radiol.2020200343
Rosa MEE, Matos MJR, Furtado RSOP, Brito VM, Amaral LTW, Beraldo GL, et al. Achados da COVID-19 identificados na tomografia computadorizada de tórax: ensaio pictórico. Einstein (São Paulo). 2020;18:eRW5741. https://doi.org/10.31744/einstein_journal/2020RW5741
Santos JLG, Menegon FHA, Andrade GB, Freitas EO, Camponogara S, Balsanelli AP, et al. Mudanças implementadas no ambiente de trabalho de enfermeiros na pandemia de COVID-19. Rev Bras Enferm. 2022;75(Supl 1):e20201381. https://doi.org/10.1590/0034-7167-2020-1381
Bradley M, Chahar P. Burnout of healthcare providers during COVID-19. Cleve Clin J Med. 2020;90(10):1-3. https://doi.org/10.3949/ccjm.87a.ccc051
Raudenská J, Steinerová V, Javůrková A, Urits I, Kaye AD, Viswanath O, et al. Occupational burnout syndrome and posttraumatic stress among healthcare professionals during the novel coronavirus disease 2019 (COVID-19) pandemic. Best Pract Res Clin Anaesthesiol. 2020;34(3):553-60. https://doi.org/10.1016/j.bpa.2020.07.008
Ceri V, Cecik I. Psychological Well-Being, Depression and Stress During COVID-19 Pandemic in Turkey: A Comparative Study of Healthcare Professionals and Non-Healthcare Professionals. Psychology Health Med. 2021;26(1):85-97. https://doi.org/10.1080/13548506.2020.1859566
Garcia GPA, Fracarolli IFL, Santos HEC, Oliveira SA, Martins BG, Santin Junior LJ, et al. Depression, Anxiety and Stress in Health Professionals in the COVID-19 Context. Int J Environ Res Public Health. 2022;19(7):4402. https://doi.org/10.3390/ijerph19074402
Mahmud N. Selection for Liver Transplantation: Indications and Evaluation. Curr Hepatology Rep 2020; 19:203-12. https://doi.org/10.1007/s11901-020-00527-9
Ministério da Saúde (BR). Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos e OPM do SUS (SIGTAP). Tabela Unificada: Procedimento - [DATASUS]. [Internet]. Available: http://sigtap.datasus.gov.br/tabela-unificada/app/sec/procedimento/exibir/. Acessed on: [01/10/2022].
Rosário M. Coronavírus: quanto custa e onde é possível fazer testes para Covid-19: Exames podem ser agendados por telefone, pessoalmente ou pela internet. Veja, 2020. https://veja.abril.com.br/saude/coronavirus-quanto-custa-e-onde-epossivel-fazer-testes-para-covid-19/ Acessed on: [08/06/2020]
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Marcos Melo, Adilson Roberto Cardoso, Cristina Aparecida Arrivabene Caruy, Derli Conceição Munhoz, Sérgio San Juan Dertkigil, André Henrique Miyoshi , Thierry Lodomez Mecchi, Isabeli Camila Miyoshi , Elaine Cristina de Ataíde, Ilka de Fátima Santana Ferreira Boin
This work is licensed under a Creative Commons Attribution 4.0 International License.
