Liver transplantation is an accepted method of treatment of end-stage liver disease, metabolic diseases with their primary defect in the liver and unresectable primary liver tumors.
The first attempt of liver transplantation in humans was done by Thomas Starzl at the University of Colorado in Denver, in 1963. After several unsuccessful liver transplantations in Denver, Boston and Paris, a voluntary worldwide moratorium discouraged liver transplantation until 1967. On July 23, 1967 Thomas Starzl performed the first successful liver transplantation.
One year later, Sir Roy Calne successfully launched liver transplantation in Cambridge, UK. Despite the fact that at least the operation seemed to be feasible, LT remained an experimental procedure until 1983 due to its low one year survival rate, which at that time was around 30%.
In that year a National Institute of Health Consensus Development was held in Washington DC. Based on the experiences from four liver transplant centers in Pittsburgh (US), Cambridge (UK), Hannover (Germany) and Groningen (The Netherlands) a consensus document was published stating that liver transplantation could be recognized as an accepted method of treatment for patients with end-stage liver disease.
By that time the first improved one year survival rate approaching 60% were reported.
Since then the numbers of performed liver transplantation constantly increased. In Europe more than 8000 livers were transplanted in 2012 (Newsletter Transplant 2013, EDQM/Council of Europe). The results of liver transplantation improved substantially over the years and currently 1-year patient survival is 85% and a long term survival is above 70%.
The COVID-19 pandemic brought transplantation to a global standstill. Since February, 2020, healthcare providers implemented a radical and focused response to the pandemic, prioritising organisational readiness and resource re-allocation to meet the anticipated influx of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Many services, including solid organ transplantation, were suspended as intensive care units (ICU) and anaesthetic resources were re-allocated. All European countries have implemented preventive screenings policies for potential organ donors and follow up of the transplanted patients.
On March 30, 2020, the European Liver and Intestine Transplantation Association (ELITA) sent out a call to establish a COVID-19 registry for liver transplant recipients to 149 liver transplant centres located in 30 European countries and affiliated to the European Liver Transplant Registry (ELTR).
As a consequence of the development of this database, studies based on the risk of COVID-19 infection in European liver transplant recipients have been developed. The preliminary results from the ELITA COVID-19 registry suggest that mortality in liver transplant recipients might be higher in older recipients than in younger patients and could be worse in patients with longer follow up since transplantation.
ELITA is planning to promote further studies on the reduction of the quantity of organs offered, impact on the mortality rate of patients on the waiting lists, patient outcomes and the role of the immunosuppression in COVID-19 recipients.
The data collected by ELITA will allow a better understanding of the clinical impact of SARS-CoV-2 on the fragile populations of liver transplant recipients and patients on the waiting list.
– Luca S Belli, Christophe Duvoux, Vincent Karam, Rene Adam, Valentin Cuervas-Mons, Luisa Pasulo, Carmelo Loinaz, Federica Invernizzi, Damiano Patrono, Sherrie Bhoori, Olga Ciccarelli, Maria Cristina Morelli, Lluis Castells, Victor Lopez-Lopez, Sara Conti, Costantino Fondevila, Wojchiech Polak,
COVID-19 in liver transplant recipients: preliminary data from the ELITA/ELTR registry. The Lancet Gastroenterology & Hepatology, Volume 5, Issue 8, 2020
– Polak, W.G., Fondevila, C., Karam, V., Adam, R., Baumann, U., Germani, G., Nadalin, S., Taimr, P., Toso, C., Troisi, R.I., Zieniewicz, K., Belli, L.S., Duvoux, C. (2020), Impact of COVID‐19 on liver transplantation in Europe: Alert from an early survey of European Liver and Intestine Transplantation Association (ELITA) and European Liver Transplant Registry (ELTR). Transplant International, Accepted Author Manuscript
– SARS-CoV-2 positive Liver Transplant Recipients and Candidates as of May 24, 2020 (click here to open)
– SARS-CoV-2 positive Liver Transplant Recipients and Candidates as of May 8, 2020 (click here to open)
– SARS-CoV-2 positive Liver Transplant Recipients and Candidates as of April 22, 2020 (click here to open)
– SARS-CoV-2 positive Liver Transplant Recipients and Candidates as of April 12, 2020 (click here to open)
Read the ELITA consensus statements on the use of DAAs in liver transplant candidates and recipients.