Successful liver transplantation for hepatitis B‐related acute liver failure in a patient with active COVID‐19.

The emergence of coronavirus disease 19 (COVID‐19) has significantly disrupted liver transplantation worldwide. Despite significant, collective experience in treating liver transplant recipients with COVID‐19, there remains a paucity of data to guide the management of transplant candidates with acute COVID‐19 who require urgent transplantation. We present the case of an otherwise well, 39‐year‐old female presenting for urgent liver transplantation for acute liver failure secondary to hepatitis B, with concomitant acute, mild COVID‐19 due to Omicron BA.2. COVID‐19 antivirals were not administered pre‐transplant as the potential risk of hepatotoxicity precipitating further deterioration of liver function was not felt to outweigh the small, potential benefit of antiviral therapy. No effective SARS‐CoV‐2 monoclonal antibodies were available; however, the patient was previously vaccinated against SARS‐CoV‐2 with evidence of anti‐spike antibodies at the time of COVID‐19. Transplantation surgery and recovery were uncomplicated with no progression of COVID‐19 post‐transplant, hospital discharge was at day 14. At 30 days post‐transplant the patient had recovered, with normal liver function and SARS‐CoV‐2 was not detectable on nasopharyngeal PCR. While the safety of transplantation of patients with acute COVID‐19 cannot be assured by a single case, ours highlights the complex decision‐making process undertaken and competing priorities that need to be balanced when assessing patients with acute COVID‐19 who require urgent transplantation. [ABSTRACT FROM AUTHOR]