Liver transplantation for acute liver failure in a SARS-CoV-2 PCR-positive patient

Lavanya Yohanathan, Cristina C. Campioli, Omar Y. Mousa, Kymberly Watt, Daniel Z.P. Friedman, Vijay Shah, Resham Ramkissoon, Alexander S. Hines, Patrick S. Kamath, Raymund R. Razonable, Andrew D. Badley, Erin S. DeMartino, Michael J. Joyner, Rondell Graham, Paschalis Vergidis, Doug A. Simonetto, William Sanchez, Timucin Taner, Julie K. Heimbach, Elena BeamMichael D. Leise

Research output: Contribution to journalArticlepeer-review


Current guidelines recommend deferring liver transplantation (LT) in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection until clinical improvement occurs and two PCR tests collected at least 24 hours apart are negative. We report a case of an 18-year-old, previously healthy African-American woman diagnosed with COVID-19, who presents with acute liver failure (ALF) requiring urgent LT in the context of SARS-CoV-2 polymerase chain reaction (PCR) positivity. The patient was thought to have acute Wilsonian crisis on the basis of hemolytic anemia, alkaline phosphatase:bilirubin ratio <4, AST:ALT ratio >2.2, elevated serum copper, and low uric acid, although an unusual presentation of COVID-19 causing ALF could not be excluded. After meeting criteria for status 1a listing, the patient underwent successful LT, despite ongoing SARS-CoV-2 PCR positivity. Remdesivir was given immediately posttransplant, and mycophenolate mofetil was withheld initially and the SARS-CoV-2 PCR test eventually became negative. Three months following transplantation, the patient has made a near-complete recovery. This case highlights that COVID-19 with SARS-CoV-2 PCR positivity may not be an absolute contraindication for transplantation in ALF. Criteria for patient selection and timing of LT amid the COVID-19 pandemic need to be validated in future studies.

Original languageEnglish (US)
Pages (from-to)2890-2894
Number of pages5
JournalAmerican Journal of Transplantation
Issue number8
StatePublished - Aug 2021


  • clinical research / practice
  • immunosuppressive regimens - induction
  • infection and infectious agents - viral
  • liver disease: metabolic
  • liver transplantation / hepatology

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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