Alagille Syndrome
Infectious Diseases

Life-saving liver transplant possible while positive with COVID-19

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A recent case study demonstrated that successful liver transplantation (LT) in a patient with decompensated cirrhosis due to Alagille syndrome was possible while positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

In the study, a 3-year-old patient with a history of SARS-CoV-2 infection 4 months prior to undergoing a LT, was exposed to SARS-CoV-2 after the decision to organ acceptance. Despite negative PCR tests prior to the transplant, a nasopharyngeal swab specimen SARS-CoV-2 PCR became positive at the operation.

The patient was treated with tacrolimus and low-dose steroids and did not receive the antiviral treatment, Remdesivir, due to potential hepatotoxicity. She continued to test positive on postoperative days 1, 2, and 5 and was discharged on postoperative day 53 without any symptomatic infection.

“This case demonstrated that a positive SARS-CoV-2 result was not an absolute contraindication for a life-saving LT. LT could be safely performed in a pediatric patient with asymptomatic COVID-19 and S-IgG antibodies for SARS-CoV-2,” the authors concluded.


Shimizu S, Sakamoto S, Yamada M, et al. Successful pediatric liver transplantation case with a positive SARS-CoV-2 test at the time of transplant: A case report and literature review. Hepatol Res. 2023 Jan 18. doi: 10.1111/hepr.13881. Epub ahead of print. PMID: 36654476.

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