Successful orthotopic liver transplantation in a patient with a positive SARS-CoV2 test and acute liver failure secondary to acetaminophen overdose
Successful orthotopic liver transplantation in a patient with a positive SARS-CoV2 test and acute liver failure secondary to acetaminophen overdose
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DOI：
10.1111/ajt.16330
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发表时间：
2020-10-23
影响因子：
8.8
通讯作者：
Modaresi Esfeh, Jamak
中科院分区：
文献类型：
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作者：
Rouphael, Carol;D'Amico, Giuseppe;Modaresi Esfeh, Jamak
SARS-CoV 2于2019年12月首次被描述，于2020年3月被世界卫生组织宣布为大流行病。各外科和医学学会根据专家意见及时发布了关于管理COVID-19患者的指南，并达成共识推迟择期手术和程序。我们描述的情况下，原位肝移植（奥尔特）的年轻女性谁提出了急性肝功能衰竭继发于对乙酰氨基酚毒性，以管理腹痛和设置的SARS-CoV 2测试阳性。尽管测试呈阳性，但她在就诊时没有呼吸道症状。阳性检测被认为是残留病毒载量。该患者的结局非常有利，可能与多种因素有关，包括她的年龄小、没有呼吸道COVID-19表现和围手术期血浆置换。我们建议根据护理标准对无并发症的COVID-19患者进行全面的奥尔特检查，对需要紧急或紧急手术的患者进行COVID-19检测的仔细解释，以及即使在初始检测后几天重复检测，因为这可能会改变管理。
SARS-CoV2, first described in December 2019, was declared a pandemic by the World Health Organization in March 2020. Various surgical and medical societies promptly published guidelines, based on expert opinion, on managing patients with COVID-19, with a consensus to postpone elective surgeries and procedures. We describe the case of an orthotopic liver transplantation (OLT) in a young female who presented with acute liver failure secondary to acetaminophen toxicity to manage abdominal pain and in the setting of a positive SARS-CoV2 test. Despite a positive test, she had no respiratory symptoms at time of presentation. The positive test was thought to be residual viral load. The patient had a very favorable outcome, likely related to multiple factors including her young age, lack of respiratory COVID-19 manifestations and plasma exchange peri-operatively. We recommend a full work-up for OLT in COVID-19 patients with uncomplicated disease according to standard of care, with careful interpretation of COVID-19 testing in patients presenting with conditions requiring urgent or emergent surgery as well as repeat testing even a few days after initial testing, as this could alter management.